In an effort to minimize any miscommunication in the selection of the appropriate breast implant size, surgeons utilize a variety of protocols. The patient’s initial consultation is the starting point. The patient is asked to define her aesthetic goals. Most patients strive for harmony in balance and proportion with her body shape. Typically, most want a natural look although some request upper breast fullness.
In describing their goals, most patients speak in terms of cup size. Although a woman may know her bra size, many do not know their actual breast size, since different manufacturers measure their bras differently. The B cup of one company may actually be equal to a C cup of their competitor. Additionally, women tend to wear bras differently; some wear them tightly while others more loosely. A small snug-fitting bra would suggest a small breast size, whereas a loose, large-fitting bra would give the impression of a much bigger cup size. Consequently, a bra size may give a general impression of the actual breast size but is not a reliable indicator when choosing breast implants.
Women frequently bring selective photos from magazines to illustrate their goals for size and shape to help the surgeon understand their preferences. However, photographs are not helpful in determining the exact implant size since the variability of height, weight, and chest dimensions vary from the photographs to the actual patient.
Many surgeons will make anatomical measurements of the breasts in relationship to the chest to help narrow the implant size choices as necessary to meet the patient’s goals. Although giving the surgeon valuable information for implant selection, this method does not help the patient with the visualized result.
Oftentimes, the use of external sizers may help give a patient better information regarding her ultimate outcome. External sizers can take one of several forms. Some women use a basic approach utilizing zip lock bags filled with rice or water and placed inside their bra. This is somewhat crude. Until recently, it was not a bad choice but limited in accuracy. Currently, actual breast implants are available which can be placed on the chest, within the patient’s bra, to help her make that determination. Silicone sizers contoured to fit on top of the patient’s breast are the most helpful, especially in patient’s with breast sagging. Using the latter approach, the surgeon, as well as the patient, is able to visualize her breast size potential using a specific volume. During surgery, surgeons may use an “internal sizer” after the patient is placed to sleep. After the subpectoral pocket is created, a sizing implant will be placed and the table will be elevated. The implant is then filled to a volume that meets the patient’s stated goals. Although fairly effective, this method does not allow the patient to see the proposed results before surgery.
Recently, the surgeons of ASI have adopted another exciting possibility in helping patient’s implant volume. Using 3D computer technology, the surgeon is able to show the patient what a certain volume will project in her actual image. She will be able to evaluate the implant volume. Satisfaction with this technique is extremely high. Unfortunately, any degree of sagging does not allow the use of the 3D imaging technique.
At Aesthetic Surgical Images, we feel that each patient has unique goals. Consequently “one size does not fit all.” Ultimately, harmony in balance and proportion are most important for a satisfactory result. An adequate preoperative consultation, physical examination and the use of various sizer techniques are essential to ensure that both patient and surgeon are on the same page in the patient’s ultimate goal. Selective silicone gel sizers and 3D computer imaging have been extremely helpful for our patients. However, even with a thorough and adequate discussion, anatomical factors may require size adjustments in the operating room to optimize the result of breast augmentation.
