When I see women in consultation for breast augmentation one of the first things I ask is whether they desire a natural looking breast or an “implant look”, which is typically more round and projecting (In my practice, most women desire the former).  I next inquire about their goals for breast size.  What size of bra do they currently wear, and what breast size do they desire post-op?  Some women, understandably, apply the logic  – “Well, since I am getting my breasts enlarged…….I might as well go as big as I can!!!”  This post will discuss how this is perhaps not the best way to look at things, and why a very thoughtful approach to choosing implant size is necessary for good outcomes and long-term patient satisfaction.

So, why is bigger not always better?  Let’s look at an imaginary story of 2 friends, Jennifer and Amy, who are 20 years old.  Jennifer is unhappy  with her B-cup breasts.  She is envious of Amy, who has much larger “DD” breasts. Let’s say Jennifer’s rates her “happiness” with her breasts at 5/10, and Amy’s rated  “breast happiness” is 10/10.  Now, let’s fast forward 15 years, after both women have had 2 children.  At this point in time, an examination of these two women would almost certainly demonstrate that Jennifer’s breasts have aged better, retaining a much more youthful appearance. Although her breasts would remain small (likely slightly smaller than at age 20 as a result of deflation from aging and childbirth), her breasts would continue to have a youthful shape, be in good position with minimal sagging, and have few, if any, stretch marks or other signs of damage to the breast skin and soft tissue envelope.  Amy, on the other hand, would very likely have significant sagging of the breasts, a downward pointing nipple-areolar complex, stretch marks, and enlarged areolae.  Now, at age 35,  Jennifer continues to rate her “breast happiness” at 5/10, while Amy’s “breast happiness” has plummeted to 3/10.

So how does all of this apply to breast augmentation? Well, when breasts are enlarged with an implant, there is increased weight and stretch added to the breast tissue.  The bigger and more projecting the implant, the larger this effect will be.  By adding a very large implant to your breast tissue, you are essentially taking on Amy’s burden of having large breasts.  This means you may be very happy with your implants for months to a few years, but as time passes your breasts will sag and stretch at an accelerated rate.  In addition, very large and overly projecting implants also have higher rates of other breast implant complications including implant migration, breast deformity, implant rupture, breast atrophy, neck and back pain, and early capsular contracture among other things.

So, how can you decrease your risk of complications and optimize your “breast happiness” over time? By selecting implants that are suited to the size of your chest wall and overall body frame, and are not excessively large or projecting.  I believe that most women want their breasts to look good not only at 1 year after breast augmentation, but also at 10 years post-op!  Increase your chances of achieving this by discussing with your plastic surgeon the implant size that will achieve a balance between reaching your size goals while minimizing complications.  Also, realize that a small compromise now (maybe going slightly smaller)  may mean years of increased happiness down the road!