Your Questions

Q: Dr. Eppley, I have interested in getting breast implants and have been researching the topic for the past six months. I have been to several consults and received differing opinions as to breast implant size. One surgeon even showed the result of an ‘extreme breast augmentation’ which frightened me. I take pictures of what I want into the consults but how do I know that is what implant size they will use? Some seem to listen to me while others I don’t think are and I am afraid they will just put in what they want.

A: Every plastic surgeon has their own approach to choosing breast implant size. Presumably the size selection should be what the patient wants. In my opinion, within reason, one should try and get as close as possible to the patient goal by using pictorial help. In the end it is not really about volume in ccs or bra cup size but what breast look the patient wants.  With few exceptions, just about any implant size can be put in most patients. I find pictures very helpful as I use them in the OR as a visual guide with the initial placement of sizers, only pulling the sterile implants once the breast looks like the pictures with the sizers in place.

There is a definite trend today, used by some plastic surgeons with great rigidity, that they will not place breast implants ‘that exceed the tissue support to sustain them’. That is a bit of a subjective assessment but what it means for some patients is that they will get smaller breast implants than they really want. While smaller breast implants are often associated with fewer long-term problems than larger ones (tissue stretch and sag), it can be a delicate balance between meeting the patient’s goals and keeping the implant size from stretching the breast tissue too much. I would sit down with the plastic surgeon in which you are most comfortable and put your objectives and concerns on the table for an open discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been researching doctors for breast augmentation this fall. I  am interested in breast augmentation and was wondering what your philosophy is about going big enough but not too big for your body. I am an A cup and would like to be a D cup. Another doctor told me a DD would put my body at significant risk for re-operation. My biggest fear is a doctor not letting me go as big and I would like or not setting the limits for too big and my body being injured. Thank you for your time!

A: Selecting breast implant size is, by far, the most discussed patient issue in the breast augmentation procedure for understandable reasons. The whole purpose of the operation is to get a larger breast size. I do not choose what size implant any patient should have, I merely help the patient select a volume that matches their desires. There is no absolute science to selecting breast implant size but through experience and the use of shaped sizers, I found that the desired result is obtained in just about every patient. I personally have never had a patient who has undergone a reoperation to get a larger breast implant size because they didn’t get what they wanted the first time. Conversely, I have had a few patients that opted for bigger implants but it was because they chose a smaller size initially.

When it comes to size selection, here is definitely a growing trend and philosophy amongst many plastic surgeons to place implants whose size stays within the existing breast base diameter and does not exceed the ability of the breast  tissues to support it long-term. When you look at the relatively high rate of breast implant revisions (nationally around 30% in the first three years after augmentation…my practice revision rate is less than 10%) it is understandable why a more conservative size approach has become popular. While the need for revisions comes from a lot of different reasons (infection, hematoma, implant failure, etc), very large implants potentially contribute to these causes. ( e.g., due to bottoming out, asymmetry, symmastia, breast tissue thinning ,etc)

What defines a large breast implant size or too large of a breast implant for the patient is going to be different based on each patient’s breast anatomy and chest/body size. For most patients, I would not think that going from an A to a D cup would constitute in my mind an implant that is too large or, more relevantly, places the patient at a substantially increased risk of subsequent breast tissue support problems. But that would have to be determined by an actual physical examination of the patient.

Dr. Barry Eppley

Indianapolis, Indiana