New Body Cosmetic Surgery Center, Pasadena, CA

Help Us Choose the Best Breast Implant For You

By Judy Brandy-Yoho, RN

Choosing the proper implant is essential in order to get great breast implant results. It's not as easy as you think. If the wrong implant is selected, the patient will generally feel they have some improvement but won't feel quite right and will never understand why. First, do you want gel (silicone fill) or saline (salt water fill) and how are they going to be inserted—which surgical approach? Look at the other parts of our website for information about this. We really like the "through the belly button" approach to the surgery because it leaves no scars on or near the breasts.

In America, there are two companies that make the implants. Both companies make silicone and saline implants. Certain guidelines must be followed to use silicone implants, but probably by the end of 2006, silicone implants will be freely available. Next, there are several shapes of implants: regular, high, moderate and teardrop profile implants. The regular implant is wider and flatter than the others. The moderate implant has more projection and a narrower base. The high profile implant has the most projection and the smallest base. The teardrop implant is fuller lower down and a flatter top. Patients with very wide chests benefit more from having a regular or moderate profile implant and patients with a relatively narrow chest wall would generally be better off with the moderate or high profile implants. Tips to remember: the wider the implant base, the lower the projection for the same volume. All implants will sag with time. The teardrop implant gives you that look right away, which most patients don't like.

As you probably know by now, most saline implants are put under the muscle (though silicone often is best above), but if you have a lot of breast tissue, you may put it over the muscle. And there are other circumstances where over the muscle might be the best choice, like certain women athletes. This needs to be discussed with the doctor.

But beyond all this, you have to understand three things:

First, your own psychological needs. Second you have to understand how your body and breasts influence the implant choice and third, you should have a feel for the implant shapes and size choices. We will help you with all this, but the more you "get it" the better the chances for a successful outcome.

So consider the following about the size and style of implant you need. There are no absolute standards. Are you a "C" cup person or a "D" cup person? Or outside this basic range? The more experience you have trying on the implants in a bra, the better an idea you will get about the size you will be most happy with. And think about the types of clothing you wear and how you will be seen with your new body.

  1. Single or newly single? Are you a young free spirit?
  2. Are there other people involved in the decision and what do they think?
  3. Do your hobbies include a lot of time waterskiing or hanging out on boats?
  4. Are you a professional who dresses very conservatively?
  5. What's appropriate for your age and how do you feel about your age?
  6. Do you think most about cleavage (between the breasts), or fullness (the top of the breast) or do you want a more saggy, "natural" look? How important is size to you?
  7. Do you think the best breasts are pointy or do you think they look best big and round? Some women like breasts which are fuller and some even like breasts which project to the side (although most women don't like this).
  8. Are you someone who has been pregnant and/or breastfeeding with "D" breasts almost continuously for several years and who now has deflated breasts, maybe even a "B" now. You may want the breasts you had during this other period of your life.
  9. Are you going to have more kids? If you are 27 and have had 3 kids, your breasts will usually stretch to whatever size you want: you can go big if that's your choice. If you are 23 and have had no children, you may want to go a little smaller. We will discuss it with you.
  10. Maybe you wear a padded bra everywhere: this can give you an idea of what you want. Eighty per cent of these women have a "C" cup with the padded bra. We usually recommend a slightly larger size than your padded bra, but it's your choice of course.
  11. Sometimes you just have to ask yourself the question if you want to find out the answer. Ask yourself: "do I want to be a D cup?" If you say "I definitely don't", then we know the answer.

Try on the support bra with different implant sizes and styles and see which one is most appealing.

OK, so you have some idea of what you want by wearing the implants and asking yourself the questions above. We must make the best compromise based on your current body and the implant possibilities. As to your body, first, what's your bra size (chest size)? The best way to measure it is to take the measurement below your breasts and add 5 to make the bra size. A 34 bra for example, would have a 29 inch measurement below the breasts so they are 29+5 equals 34 inch bra size (for people with very broad shoulders, this might not hold perfectly true: a woman like this might fit into a 36 and the straps might fit better). The cup size is a volume measurement you will have to get a feel for by trying on various bras with implants. Most women want a large C or small D cup here in California but we can produce other sizes if desired.

One of the most basic concepts is that the implant should be centered under the nipple, or sometimes centered a little high as the lower part of the breast tends to stretch a bit. If you have nipples that point out to the side, you may not have a lot of cleavage unless you get an implant that is very broad-based and probably large. If you have nipples at different heights or breasts that are at different heights you might consider a nipple lift (crescent mastopexy) or some other type of improvement surgery along with the implant procedure. Larger chest sizes such as 36 or bigger have similar considerations as when the nipples are located out to the side. These women usually need a somewhat larger implant or at least one with a wider base diameter in order to produce proper cleavage. This usually means a larger cup size unless you are going to be happy with less projection.

Body style is important, too. You need to choose a size and style of implant that is appropriate for your upper versus lower body and your weight. And if you have long skinny breast(s)—"tubular" breasts—you are a special case and need special implant consideration and sometimes a different surgery than with ordinary implants.

The goal is to get some cleavage but avoid the breast hanging out into the armpits. Obviously your breast plus the implant equals the cup size. A higher profile implant gives more fullness on the top of the breast, a look you may or may not want. High profile implants are usually more obvious to everyone than lower profile implants. The higher profile implants picks the breast up more than the lower profile implant. These can work with some breasts that are a bit saggy if the right size is used. And they may "ripple", or show through the skin at the edges, less than lower profile implants of the same volume.

And a few other rules of thumb:

  1. Don't worry about the volume so much when you try on the implants. Instead, think about how you feel with the different sizers and the support bra. We're trying to figure out what look you want: it's not obvious until you work with the implant sizers.
  2. If you are switching out your implants for a bigger size, you won't have much of an effect unless you go at least 100 to 150 cc larger.
  3. Though you may not believe it at first (and of course it's always your choice ultimately) if you get implants smaller than 350 cc it's unlikely you will be completely satisfied.

Note that although there was some older information that said "textured" implants were less likely to cause a thick scar around the implant than smooth implants, newer science says that the smooth implants are just as good. So we use smooth implants because they are not as easy to feel. Also remember: your breasts are sisters, not twins, and unless you want some scars (sometimes minimal scars) you need to understand that you will likely not get perfect symmetry. That said, we often improve symmetry with implant choice and fill.

So you see that these choices require a lot of experience for the best possible result. A doctor who puts the same style of implant in all of his patients is unsophisticated and gets inferior results. Learn as much as you can about the process and if the doctor can't answer your questions about your body and your needs, go elsewhere. The choice is ultimately up to you.

Click here to find out more about Los Angeles Breast Enhancements.

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