Breast implants: What size is best? Introduction Many say the bigger, the better in terms of everything. The bigger your house or bank account or party or business, the better. When it comes to breasts, women want them big to get noticed by men, and men do notice them. The advertising industry and the general mindset encourages this. The thing is that apart from sometimes looking rather absurd to have too much cleavage, it also can be risky to your health. That is why one of the biggest and important questions to find the answer to before going under the knife to transform your breasts should always be: what size is good for me? Basic information Breast augmentation is cosmetic surgery: a plastic and reconstructive one. This type of surgery is used to provide symmetry when the breasts are uneven in shape, to enlarge the breasts that are small, to provide fullness and restore breast shape after weight loss, pregnancy and breastfeeding, and, to restore a breast after a partial or full mastectomy. This is done by inserting implants that are a medical device produced especially for this purpose. Types of implants Breast implants are of different shapes and sizes and textures, and that is why it is very important to know about each one and their advantages and disadvantages. There are two main types of breast implants: silicone and saline solution implants. The outer shell of both is made from silicone, the difference being just the filler substance. Let’s look a little closer at these two kinds of implants. Silicone implants It is the most common and the first ever used kind of implant for breast augmentation. The silicone gel is said to feel more like the natural breast tissue. If the implant shell breaks and the silicone leaks outside it, the breast might not change its shape at all or only after a while. That is because silicone is a dense and coherent substance that will not lose shape easily. Even if this might seem an advantage, the thing is that the silicone gel spilling in your body is not healthy at all and can lead to serious disease. That is why patients who have chosen silicone implants are required to go for regular check-ups and MRIs to discover if they are leaking or not. You don’t realize it yourself if the implants are okay or not since the shape or size does not change. Silicone implants were forbidden to be used in the US due to a series of trials and concerns between 1991 and 2006. In between this time, an extensive study was ordered by the FDA to evaluate further if these implants are safe to be used or not. So in 2006, silicone implants were again approved and began to be used again in the US. The study has revealed no direct connection between breast cancer or connective tissue disorders and silicone implants. Nonetheless, silicone is not a natural compound, so in case of rupture, implants should be immediately removed. Saline implants These implants also have a silicone shell, but they are filled with sterile saline water. Saline implants are firmer than silicone ones, and so they have a rather different fill and texture than the natural breast tissue. Unlike silicone implants, saline implants come deflated from the manufacturer, and they are filled in with the sterile saline solution by the surgeon during the operation. For him to be able to do so, they are provided with a valve, and this one can be a source of leakage. Still, they are considered by some safer because if the shell breaks, the saline solution is naturally absorbed by the body. It is easy to recognize when a shell rupture happens in this case, because unlike silicone, saline water is just water that when it leaks immediately, it triggers a visible change in breast volume and shape. Apart from these two main types of implants, there are some more variations of them. There is a type of saline implant called structured saline breast implants. They are rather new to the market and their structure allows them to have a natural as feel as silicone ones, and at the same brings peace of mind to the bearer in case of a rupture. There is also the gummy bear breast implant (not filled in with real gummy bears!) that only takes their name because their structure is like that of the gummy candy. Their main advantage is the fact that they never change shape in case of rupture. The consistency of the gel is thicker than that of the traditional silicone implant. This kind of implant is also known in the plastic surgery world as anatomically shaped or teardrop implants. Round implants are the most common implants used by surgeons but also preferred by women. For doctors, it is easier to work with a round one since whatever direction you turn it, it will still be round. Many women consider that a round implant will make their breasts even bigger and rounder and seem even fuller. Still, the round shape can look unnatural sometimes and look fake. An advantage of this shape is that the implant rotates and there will be no change in your breast shape. Teardrop or anatomically shaped implants are maybe the most natural choice if that is what you want. It is a very challenging implant to be placed by a surgeon since he must put it in an exact place, otherwise it will look wrong. But if your doctor is experienced in such procedures, then you do not need to worry. The implants can also be structured or smooth. That refers strictly to the outer surface of the silicone shell. The smooth one is free to turn and move inside the breast pocket, while the structured one sticks to the tissue and muscles due to its surfaces. Structured implants were made out of the necessity of preventing capsular contraction. Measurement and size All the details regarding the kind of implants you will have will be discussed with your plastic surgeon. But one of the most important matters to talk about is the size of your implants. It is important to know that the fullness of your chest can be given by other means than the size of the implant. You will probably have a general or fixed idea of what breast size you will like, and this should be discussed. That is because sometimes what you want is not what can be done or what suits you aesthetically and anatomically. To determine the perfect size of your implants, the doctor will perform a range of measurements and then talk about the size. These measurements include the breast and tissues and are called soft tissue-based planning. First, they will measure the soft tissue of your breasts and then there will be an assessment of your tissue to discover its elasticity and thickness. A tight tissue will not allow a bigger implant, whilst a lax one will require a higher volume of fill. So, if you are a young woman that has never been pregnant with firm skin, you will need to have a smaller size implant. But if you already have children and have breastfed them, you will be able to get a bigger implant. You need to be flexible and if your doctor advises you to get a smaller size implant than desired, accept this without a doubt. A larger than necessary implant might have serious consequences on your health. If your tissues do not allow it, they will not be able to carry it, and it would be like trying to carry too many kilograms in a plastic bag: it will break under stress. Also, it can lead to tissue atrophy, deformities of the breast that might not be ever corrected, capsular contraction, and more. Take into consideration that any of the above will lead to a new surgery and the rate of success for corrective surgery is lower than an initial one. Breasts that are too large compared to your natural anatomy will also feel and look fake, and most probably will be a burden than a reason for happiness and confidence. Another method for deciding on breast implant size is using a bag of rice. It supposes placing bags filled with rice in your bra and discovering in this way what size fits you best. This method is very common but not as accurate. This is because it does not take into consideration the breast tissue. It is based only on the look and the way you feel with it. But these factors are not really important when the implant is part of your breast. That is why many good surgeons do not use this imprecise method. In recent years, the measurement method has been complemented by 3-D imaging. Some doctors use just the 3-D system to decide together with their patients the size and type of implant. Using your data and pictures together with the available type and sizes of implants, they will show you on a computer the way you will look with each one. This is a relatively easy method, and it will probably give you a more picturesque idea of what to expect. But 3-D imaging alone does not consider your tissues either. The ideal decision should be taken according to both measurements and the 3-D system. After having the results of your assessment, your doctor could show you the implants that will suit you, and you will get an idea of how they will look on you. Conclusion Size is a tricky decision because sometimes our expectations are higher than possible. You should consider that if your doctor denies you an implant size that you wanted, then he might be a very good surgeon. And that is because apart from making you happy on the spot, he is also a responsible doctor who also thinks of your health, the risks implied by a wrong type or size of implant, and the long-term results. If you want people to not even think for a minute that your breasts are not natural, then you need to listen to your doctor’s advice and choose what he tells you is best both for your look and health.