My practice approach to size in breast augmentation is that it is the patient's choice.I do not judgeIsomeone's taste or desires. Breast size is a very individualized issue and is of great interest to every patient. To achieve this objective, I always ask the patient to show me pictures of what size they think looks good and then I try and match that size concept in the operating room. While I always make breast measurements, the most important measurement in my opinion is the base diameter of the patient's breast. Women do not want a breast implant that goes too far to the side and gets in the way of arm movement. Therefore, I keep the breast implant size to no greater than the existing breast base width. If the size is going to exceed the breast base width, then I choose a breast implant of the same size that has a higher projection. In higher projecting breast implants more of the implant's volume comes forward and less to the side.

In the majority of breast augmentation in my practice, I find that most women select sizes that would be viewed as 'reasonable'. Most of my breast augmentation patients choose breast implants in the size range of 300cc to 450cc. The remaining 10 - 15% of my patients are anywhere from 450 - 700ccs. In a taller and heavier patient, these breast implant szies may appear not unduly large. In more petite women, these breast implant sizes may be viewed as too large.

While, on the one hand, it is not my concern when a patient opts for a very large breast implant, I always feel compelled to make them aware that there are some long-term consequences to that choice that they need to be aware of. First and foremost, it is easy to increase the size of the breast but it is difficult to go the other way. To go down in breast szie later in life, the excess skin may also have to be reduced to maintain a good breast shape, resulting in breast scars. Secondly, the bigger a breast implant, the more pressure it exerts on the remaining breast tissue resulting in long-term loss of their remaining breast tissue. In many large breast implants over time, the patient will only be left with skin and a breast implant with little breast tissue in between. Lastly, the weight of a very large breast implant over time may cause the entire breast to sag, weakening the skin support of the breast under its own weight.

Patients who choose large breast implants also need to appreciate that a woman's perception and goals of her breasts will change throughout her life. Like that nice cute tattoo that was put on in your twenties, it may not look so cute when you are forty.