Breast augmentation is a very popular procedure, with almost 300,000 breast augmentations being performed in 2010 in the United States. (American Society of Plastic Surgeons 2010 Statistics) Breast implants come in many different sizes and shapes. Most implants inserted for cosmetic purposes in the United States are round implants, of varying projections. Depending on the set diameter of the implant when it is manufactured, only so much saline or silicone can fit inside of the implant shell. Those implants that are flatter and don’t project much are called low-profile implants. Those that are more round and more projecting are called high-profile implants. Low profile implants are not used that often. Medium profile implants are most commonly used for cosmetic breast augmentation. High profile implants are sometimes used for cosmetic breast augmentation, but are most commonly used for breast cancer reconstruction cases, to replace the breast tissue that has been surgically removed.
Every woman’s body is different and the size and shape of both the breasts and the chest wall vary among individuals. The skin and the overlying breast can only fit a certain volume of implant behind them. One of the most important measurements to be made when determining the best size implant for a woman is the diameter of the chest underlying the breast. This measurement is called the base width and corresponds to a certain range of implants with the same diameter that can fit underneath the breast. Within 1 cm of the patient’s measured base width is a range of implants that would fit the woman’s chest fairly well. This usually corresponds to a range in sizes that are about 100-150 cubic centimeters (cc’s) apart. An implant on the lower end will give a more conservative augmentation, while one on the higher end will give a more noticeable augmentation. For example, for a woman with a base width that measures 12 cm, she would be a candidate for implants that range in base width from 11 to 13 cm. The corresponding implant sizes for a base width of 11, 12, and 13 cm, would be 250, 300, and 400 cc, accordingly. This is just an example and the exact numbers depend on the implant manufacturer and specific implant being used.
There are multiple risks of having a breast augmentation performed with implants that are too large for the patient. If the implant is significantly larger than the potential space on the chest, then changes occur to the overlying tissues over time. These include thinning of the skin and tissue on the bottom of the breast, stretch marks, rippling, and bottoming out of the implant. These all result from the weight of the implant and the force of gravity pushing down on the implant over time. This leads to higher rates of revision surgery for cosmetic breast augmentation. Often, these problems are difficult to fix and involve another surgery to lift the breast and place a smaller implant.
The specifics of the breast augmentation procedure and potential implant sizes should be discussed with your plastic surgeon at the consultation. Measurements should be made and sample implants should be shown. It is important to ask questions and understand all the risks to the surgery.