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How can I know what cup size I will be after implants?

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Many questions have a simple answer and a more complicated one. The simple answer to this question is: you can’t, at least not precisely. The more complicated answer has to do with all the variables that come into play when discussing breast implants and size.

Most women know that when they buy bras of the same cup size from different manufacturers, they may not fit the same way. Different cup sizes from different manufacturers may fit the same. The reason for this, and what makes discussions of breast size so difficult, is that there is no standard for what an A, B, C, D, or other cup size really is. In a vault somewhere, in the National Bureau of Standards, there is a 12 inch ruler that is the standard for what 12 inches means. All rulers are made to that exact standard so that all 12 inch rulers are of identical length. No comparable standard exists for bra cup size. All manufacturers make bras to their own particular standards, which is why a B cup bra from one manufacture may fit you the same as a C cup from another.Victoria’s Secret bras are consistently smaller than other bras. I think this is to make their customers feel good that they can wear a C or D cup, when bras purchased elsewhere are B or C cups, respectively.

There are also multiple methods for measuring women for bra size and these can yield different cup sizes for the same person, further adding to the confusion.

Patients frequently come in requesting a particular cup size that they wish to be after their implant surgery. There is no direct correlation between how many cc’s of fill an implant contains and what that implant will do to a specific patient’s cup size. I have seen the same implant not increase the cup size at all (the patient simply filled out her existing bras more fully) in one patient, increase cup size by one in another patient, and increase it by two cup sizes in yet a third. There is no formula or computer program that can precisely and consistently predict what cup a patient will wear after their surgery. Some women like to wear their bras tighter, others looser, and some like padded versus non-padded bras. The variations are endless.

Another challenge for the breast implant surgeon is to anticipate what will make the patient happy. This can be difficult to do. We cannot put ourselves into the patient’s mind to know with certainty what they are looking for. We listen to what patients tell us. Some patients are very concerned about being too big after surgery and in those, we will be a bit more conservative with our choice of implant. Others want to be very full, even “showy” , and for those we will choose a larger implant. Some patients want the biggest implant we can give them, regardless of whether they will look natural or not.

To “size” patients, I first listen to what they tell me their desires are. I ask questions and try to determine to the best of my ability what they are seeking. I examine the breasts to assess their natural size, shape, presence of asymmetry, looseness of the skin, quality of the breast tissue, and anatomy of the chest. I take measurements. Putting all of these together, I can come up with an educated guess, or at least a range, of sizes that might work. I do not make a final decision until surgery. There, I prepare the breasts for the implants then insert a breast sizer, a temporary implant that I can inflate to any size I wish. By doing this I can see and feel, exactly what the implant does to the breast. Knowing how the implants are likely to settle out, I can usually choose a nice size and one that the vast majority of patients will be happy with. There are always 3 other people in the room with me; two nurses and an anesthetist, and everyone has an opinion. I cannot recall that we have ever disagreed on what looked best for any patient.

Some women overlook the fact that what they give me to work with will determine, to a great extent, the best implant for them. Patients with smaller body builds, smaller breasts, tighter skin, etc. will obviously not be able to accommodate the same size implant as someone larger, with more, looser skin will. If I try to put too large an implant into a breast, I will stress the tissues more and there is a greater chance that the implant will not settle properly, that it may buckle or fold (which raises the risk of implant failure and leakage), that it may be too easily seen or felt, and/or that the breast will not look good years down the road.It is always risky to compare oneself with one’s friends who have had implants as their situation may have been very different. Ultimately, every patient is unique and cannot be fit exactly into the same mold as someone else.

Some young women, that have a very nice result from implant surgery, come in seeking larger implants because of everything from their own dissatisfaction, to peer pressure, to pressure from a partner. This poses a dilemma for the surgeon because going bigger is not as simple as changing out one implant for another. For one thing, the established implant pocket will have to be enlarged, which is more surgery. For another, the added size and weight of a larger implant may place very different dynamic forces on the tissues, affecting how the breast will look later. Bigger, heavier implants increase the risk of sagging later. Breasts that are too big  can create issues with back, neck, or shoulder pain; the types of problems we see in women seeking breast reduction surgery. They may limit women who wish to be physically active in engaging in athletic activities because of difficulty finding adequate support. Finally, exchanging implants subjects the patient to all the risks of an additional operation, including the risk of something happening that might ruin an otherwise great prior result. There is a saying in plastic surgery that applies: “the enemy of good is better”. From an aesthetic standpoint, implants that are too big just never look natural and some patients look odd, even bizarre with breasts that are too large.

The discussion of sizing and what to expect from implants is one of the most important aspects of preparing patients for what to expect and is something I spend a great deal of time on, from the very first consultation. Even so, it is not possible to anticipate ever contingency, which is why I tell patients that I cannot guarantee they will be satisfied with the size implants chosen. In my experience, patients who select their own implants are more often dissatisfied than not, usually because they choose too small a size. I suggest patients allow me to size them but I always allow for the possibility of some patients (less 1% in my experience) seeking different size implants later. I offer this type of revision at cost to cover my expenses and the cost of a new pair of implants. I do not charge for my time when doing this. I feel this is fair as both of us are picking up some of the cost of the revision.

Finally, never undergo breast implant surgery for anyone but yourself and don’t seek out larger implants unless it is for the same reason. If your partner wants bigger implants, let him get his own!

Breast sizing is part of the “art” of plastic surgery and as such, while the vast majority of patients are very happy, a few may find themselves seeking larger or smaller implants later.

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Like most surgeons, Dr. Bosshardt Loves to operate and wield his scalpel in the practice of his craft. In addition to his role as a surgeon to help his patients with their cosmetic and reconstructive concerns, he loves to wield his pen for the purpose of educating, encouraging, and empowering his readers to live a fuller and healthier life. As human beings, we have been gifted with an incredible and unique physical body capable of extraordinary things. It is his hope that his writing will help readers learn a little more about plastic surgery but, even more important  that it will not just inform, but inspire, readers to take care of their bodies and make the most of their physical potential to live life to the fullest, whether with or without plastic surgery.  


 


Dr. Bosshardt is a fully trained general surgeon and plastic surgeon, board certified by the American Board of Plastic Surgery. He was fortunate to obtain his training in plastic surgery from Dr. D. Ralph Millard, an icon in the field and acknowledged to be one of the top plastic surgeons of the past millennium. The training was unique in stressing not just learning surgical techniques and procedures, but principles as well. These principles can both guide the plastic surgeon in perfecting their craft and anyone in living a better life. 


 


Dr. Bosshardt has been in private practice in Lake County, FL for 23 years. In addition to plastic surgery and writing, his passions are endurance sports, particularly triathlons and marathons, and, most especially, his family including wife, Sally; children, Lindsey, Travis, and Olivia; son-in-law, David; and grand daughters, Emerson and Elliette. 


In November 2013, Dr. Bosshardt successfully completed the Florida Ironman triathlon in Panama City, FL in 13 hours, 36 minutes, and 33 seconds, capping off a year of dedicated training.


 


 

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