This dilemma occurs primarily because women associate breast implant sizes with bra cup sizes, despite the fact that the volume of breast implants has no direct relationship with particular cup sizes.

Thus, the first and perhaps most important thing that breast augmentation patients choosing a breast implant size must understand is that bra cup sizes vary wildly from retailer to retailer and are not an exact measurement of breast size. Breast implant sizes are measured by exact volume in cubic centimeters (cc’s), so while a cup size might give you a ballpark range of the overall breast size you are trying to achieve, they will not help you choose an exact breast implant size.

Try to put the idea of C cup and D cup out of your mind while you consider your options. Also, remember that your natural breast tissues will also contribute to the overall size of your breasts after implants have been placed provided your implants are not part of a breast reconstruction procedure.

Breast Implant Sizes

A great place to start your journey to understanding breast implant sizes is with the range of implant sizes or, rather, volumes available in the U.S. There is slight variation in size availability for saline and silicone breast implants, however in general, breast implant volumes range from about 120cc to 850cc.

Saline implants can be overfilled to achieve a slightly larger size, however most patients do not want breast implants that large. In fact, some states even dictate that plastic surgeons may not supply patients with breast implants larger than a certain size (usually 1000cc to 1200cc).

In choosing a breast implant size, it also helps to remember that your skin must stretch to accommodate the implants you choose, so if you have poor skin elasticity or are prone to stretch marks, your cosmetic results may be best if you choose implants that will not put undue stress on your skin.

Breast Implant Profiles

In addition to different volumes, breast implants also come in four different profiles: low, moderate, moderate plus and high profile. The implant profile affects the projection of your breast implants, and although they are not directly related to the implant size, they can affect how large or natural your breasts appear.

The greater the profile of your breast implant, the greater the height of your breast side wall. Many patients who desire more upper pole fullness, or cleavage, and are less concerned that their implants look natural choose high profile implants, as do patients with very narrow breasts.

Tools to Help You Choose a Breast Implant Size

There are many tools Dr. Branman can provide you with to help you visualize how different breast implant sizes would look after surgery. Although none of them offer an exact representation, they can still give you a general idea of the look and proportions implants would create.

Implant sizer bras are helpful to some patients as they struggle to imagine how they would look with larger breasts. Sizer bras have pockets in them designed to hold replica breast implants of different sizes, allowing you to contrast and compare the effect different breast implant volumes has on your contours. Try on sizer bras with a swimsuit, t-shirt and other tops to see a general approximation of the effect breast implants would have.

A measuring tape can also be a great help. Having your surgeon take measurements of your chest wall dimensions will help you get a better understanding of your existing body proportions and how they would change with different breast implants. Your surgeon will provide you with appropriate context and a brief anatomy lesson during this stage of the decision-making process.

One of the best resources available to patients choosing a breast implant size is their surgeon’s gallery of  breast augmentation before and after photos. Looking at before and after photos of other patients who share a similar build, existing breast size and desired breast size can provide some of the most useful direction to women considering implants. Review as many before and after photos as possible as you make your decision.

Input From Your Surgeon

Dr. Branman will certainly help guide you throughout the process of choosing your ideal breast implants. However, keep in mind that decisions about your implants, including their size, must ultimately rest with you.

Be sure to choose a surgeon who makes you feel comfortable asking questions and gathering all of the information you need to make an informed choice. While Dr. Branman has spent many years helping women in Little Rock choose their breast implants and can offer you invaluable input, you must feel confident in your decision to ensure your expectations for breast augmentation are met.

While some patients have strong feelings about which type of implant they prefer, others have a difficult time determining whether saline or silicone implants are the best choice to help them reach their goals.

Look and Feel

Both silicone and saline implants can give you a natural look, particularly if the implants are placed under the chest muscles, however silicone breast implants have a reputation for providing a more natural feel.

This makes sense, given that silicone implants today are made of a cohesive gel material that more closely mimics the weight and suppleness of natural breast tissue than liquid saline solution.

Patients who are very thin or have little natural breast tissue to cover their implants are often good candidates for silicone gel implants because the implants are softer and less prone to rippling, allowing for a more natural look and feel.

Patients with pronounced asymmetry in the size of their natural breasts may also be good candidates for saline implants, as the volume of saline solution in each implant can be adjusted to even out the breasts.

Scarring

Saline breast implants are composed of an outer silicone shell and a filling of liquid saline solution. Because the saline solution can be added after the implant shells have been placed in the chest wall, the incisions needed to place saline implants are slightly smaller.

There are also more options as to where incisions can be placed with saline implants. Unlike silicone implants, which can be inserted only through incisions in each breast fold (inframammary incisions) or along each armpit (transaxillary incisions), saline implants can also be inserted through incisions around the border of each areola (periareolar incisions) and even through the belly button (TUBA incision).

Thus, saline implants result in smaller scars (about half an inch smaller) than silicone implants and offer more options for patients in terms of where their breast augmentation scars are located.

Safety

In 2006, the FDA ended a 14-year moratorium on silicone breast implants that was instituted because lawmakers felt there was insufficient evidence to rule that the implants were safe.

After years of rigorous testing, the FDA allowed silicone implants to re-enter the market because no scientific data had been produced to link silicone implants to systemic diseases they were previously assumed to cause.

From a scientific standpoint, the safety of silicone implants and saline implants is identical. The only difference between the two from a legal standpoint is that patients must be 22 to have silicone implants, whereas they can be as young as 18 to have saline implants.

Patients who choose either option can rest assured that all FDA approved breast implants are safe and will not directly affect your health and wellness in any way, positively or negatively.

Breast Implant Cost

Breast implant manufacturers charge about $1,000 more for silicone breast implants than saline breast implants, so breast augmentation with silicone implants is slightly more expensive initially.

Also, consider that patients with silicone implants should have an MRI three years after surgery and every two years thereafter, as there is no other way to detect breast cancer or implant ruptures with silicone implants. Saline implants, on the other hand, do not require an MRI to detect cancer and will visibly deflate if they are ruptured.

Due to the cost of periodic MRIs, the cost of maintaining silicone implants can be slightly higher in the long run.

The Bottom Line

It is easy to get overwhelmed evaluating the pros and cons of saline and silicone breast implants, but before you do, remember that you have a guiding light in this process: your cosmetic surgeon. Dr. Branman has more than a decade of experience and has helped hundreds of Little Rock breast enhancement patients choose the best breast implants to meet their unique needs.

Trust Dr. Branman to help you make this important decision, and feel free to ask questions, talk to other breast augmentation patients and look at plenty of breast augmentation before and after photos before you decide on silicone or saline breast implants.

If a woman with breast asymmetry is considering a breast augmentation, she should be aware that the asymmetry may be more noticeable  after an augmentation. Therefore it’s crucial for surgeons to evaluate the components that contribute to breast asymmetry, according to those who participated in a panel on the subject at the recent annual meeting of the American Society for Aesthetic Plastic Surgery.

“It is important for surgeons to assess the patient’s breast symmetry before operating to determine whether the surgery is necessary and if it will make the asymmetry more obvious,” said Dr. Jack Fisher, the panel’s moderator.

Patient Satisfaction & Breast Asymmetry

According to Dr. Laurie Casas, the key to a high patient satisfaction rate is “to fully inform the patient that this kind of augmentation is extremely challenging, but that using a detailed analytic approach, we can achieve a very aesthetically pleasing outcome within the limits set by their preoperative anatomic characteristics.”

When developing a breast augmentation plan for those with breast asymmetry, cosmetic surgeons must evaluate all elements that contribute to it, such as volume, nipple position and chest wall deformity, in order to increase patient satisfaction.

Before breast surgery on those with breast asymmetry, the surgeon should be clear with the candidate about the challenges the asymmetry poses, so that patients have realistic expectations about their results.

New technology, such as 4-dimensional imaging, can also help manage patient expectations during the consultation process.

Learn more about breast augmentation, which can help patients achieve better symmetry when breasts differ moderately in size and shape.

The latest study found that the fat transfer breast augmentation procedure — in which fat from other parts of the body is transferred to the breasts — can cause false suspicion of breast cancer on follow-up mammograms.

According to the study by Dr. Cong-Feng Wang of Meitan General Hospital in Beijing, mammographic changes occurring after fat injection are indistinguishable from abnormalities associated with breast cancer. Based on this “mammographic confusion,” the authors concluded that the use of fat injection for breast augmentation should be “prohibited continuously.”

The earlier study, by doctors in France, included a descriptive analysis of 31 patients who had follow-up mammograms after fat transfer for breast augmentation, a technique the authors call “lipomodeling.”  Microcalcifications were visible on five mammograms (16 percent), but the authors wrote that with the use of modern radiographic techniques “radiologists can now easily distinguish between calcifications resulting from fat necrosis and those associated with cancer.” They concluded that none of the changes were considered likely to raise suspicions of breast cancer on routine mammograms.

The new study looked at 48 women who underwent fat transfer, which the authors refer to as “autologous fat injection for breast augmentation.” They found eight cases (16.7 percent) with clustered microcalcifications in postoperative mammograms. While the microcalcifications rates were very close in the two studies, the authors of the new study concluded that in all eight cases the microcalcifications were regarded as “highly suspicious” for breast cancer.

Both studies were published in Plastic and Reconstructive Surgery journal, the official journal of the American Society of Plastic Surgeons (ASPS). An ASPS release noted the conflicting studies and said that the results “highlight the need for caution — and for more scientific evidence on the mammographic changes occurring after fat injection.”

“Radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure,” concludes the study, led by Dr. Michaël Veber, of University of Lyon-Léon Bérard Cancer Center, France.

The fat grafting procedure is done by taking small amounts of fat from one part of the woman’s body, such as the hips or thighs via liposuction, and transferring it to the breasts.

To determine whether fat transfer for breast augmentation — which the authors call lipomodeling — caused any problems with mammogram screenings for breast cancer, the researchers reviewed mammograms performed 16 months, on average, after lipomodeling in 31 women. In over half the cases, the mammograms showed no abnormalities.

Some women’s mammograms showed small calcifications or cysts as aftereffects of the fat transfer procedure, and a few women had other abnormalities related to scarring from their breast surgery. However, the authors concluded none of these changes were considered likely to raise suspicions of breast cancer on routine mammograms.

The researchers also evaluated mammograms performed before and after fat transfer in 20 women. They found there were no significant differences in the mammographic results from before to after the procedure, and there was no increase in abnormal results that would cause suspicion of breast cancer.

Overall breast density remained stable over time, and most importantly, “radiographic follow-up was not more difficult after lipomodeling,” according to the study.

The authors suggest that women undergoing lipomodeling have a complete evaluation — including mammograms — before and after the procedure.

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Erica says before her breast augmentation she described herself as being in the “negative category” for breast size, while Jeanne was a triple D and only 4’9”.

“It’s a constant struggle for me in my small frame to be active,” says Jeanne of her breast size before her reduction. In addition, she had neck, back and shoulder pain and rashes under her breasts.

Both women wanted to be a C cup, and they achieved it through cosmetic surgery.

The ladies appeared on the TODAY Show about two weeks after their surgeries.

Jeanne says that after surgery she saw her stomach for the first time in the shower.

Erica, who chose silicone implants, says breast augmentation is something she’s always wanted to do and that she’s more than happy with the results.

The women’s surgeon, Dr. Steven Teitelbaum, says that there is more scarring with breast reduction than augmentation, although the scarring for reductions is less than it used to be and that surgeons have gotten better at shaping the breasts in reductions.

“Implications from this correlation found in our study include possibly improving implant volume predictions preoperatively, leading to improved efficiency, outcomes and reduced reoperation rates,” the researchers wrote. They also said that a patient’s BMI could potentially provide an additional data point on which to make operative planning decisions.

The study examined 100 breast augmentation cases each in the three cities in order to gather patient demographics, which the authors said were lacking from other research, despite the increase in the procedure. According to statistics from the American Society of Plastic Surgeons, there has been a 45 percent increase in women seeking breast augmentation since 2000.

In addition to BMI and implant volume, the study also gathered data on each patient’s height, weight, age and the number of children the patient had.

The three geographic group medians were significantly different for weight, BMI and implant volume. The Canadian city had the lowest BMI and Temple, Tex. had the highest. Temple patients had the smallest average implant size, significantly lower than the other two cities.

The study also looked at the combined data for all 300 patients and found, on average, the breast augmentation patients studied were 34 years old, 5’ 4” tall and 128 pounds.

Learn more about breast augmentation in Little Rock, Arkansas.

Macrolane — by Q-Med, the makers of Restylane — is a gel that adds volume to tissues and can be used for restoring and enhancing body contours or for filling concave deformities and scars. It provides results without open surgery and the scarring at the injection site is minor and is likely to become less noticeable with time, according to Q-Med.

Currently Macrolane is used in Europe but is not yet approved for use in the U.S. It’s been “well established for use in esthetic facial procedures” according to the study. A new formulation may make it suitable for breast enhancement as well.

The study was done in Sweden with twenty women who received injections of the gel under local anesthesia. The study found high subject improvement rates for breast appearance (83%) at 6 months post-treatment. At 12 months after treatment, 69% of breasts were still considered improved. The decline in satisfaction after a year is related to the fact that results with the gel are not permanent, so those looking for permanent enhancement may be better off considering traditional surgical enhancement with breast implants.

The highest levels of satisfaction were observed in relation to the shape and general appearance of the breast, although comparable trends were also noted for size and firmness, according to the study.

The researchers concluded that “NASHA-based gel is a new option for the patient population who desire esthetic improvement of the breast but who do not want to undergo surgery.” They stressed that further studies in larger numbers of patients are warranted.

Cytori’s process for breast augmentation and breast reconstruction involves using liposuction to harvest fat cells, and then injecting the fat into the company’s Celution System, where a centrifuge separates the fat cells from the stem and regenerative cells and prepares the cells for injection. Finally, a surgeon injects the cells into the breast for the enhancement or reconstructive procedure.

The process works because the fat cells in the mixture provide volume and the regenerative cells encourage the growth of a blood supply that the fat cells need to survive.

Cytori has chosen to focus its technology on breasts because they don’t have much function beyond feeding a baby. “The scientific and regulatory hurdles to getting Cytori’s cells into clinical use will be easier to clear for breasts than for other tissue: Breasts simply aren’t as necessary as other organs, so the bar for proving to regulators that the technology works will be lower,” writes the author of the article.

With almost a decade of trials on cell cultures, lab rodents and now humans complete, Cytori believes the same technology it is using for breast procedures could be used to regenerate other damaged tissue, such as in the heart or kidneys. However, Cytori’s system has not been FDA approved, so it can’t be marketed in the U.S., although doctors can purchase it.

While fat grafting for breast augmentation has been a relatively obscure procedure, new studies, such as this one, present some evidence that it could be effective and have long-term results for breast enhancement.

The study by Daniel Del Vecchio, MD, and Louis Bucky, MD, was conducted over a two-year period with 25 patients who had breast enhancement with fat grafting. The study’s authors stressed the importance of patient selection and external pre-expansion of the breasts for the success of the procedure.

Prior to the procedure, all patients were photographed and had intravenous contrast MRI and/or 3D breast imaging, followed by three weeks of expansion, such as wearing a suction bra every day. Six months after the procedure, patients were again photographed and had the other breast imaging tests.

Six months after surgery all patients had visible breast volume increase, with a mean volume increase of 250 cc per breast.

The authors concluded that this technique can be “performed in a time efficient manner with reproducible, long-lasting results.”

“While the procedure is gaining scientific validity and traction among plastic surgeons, it is not the same as having breast enlargement with implants,” noted a release by the American Society of Plastic Surgeons. The study was presented at the society’s annual scientific meeting.

In the past there have been concerns about the procedure because some of the side effects such as oil cysts, calcification and tissue scarring were difficult to distinguish mammographically between calcifications associated with breast cancer vs. those associated with fat transfer. More recently, however, radiology literature suggests that new generations of mammography equipment, especially digital mammography, are better able to distinguish cancer cells from benign ones. View the  study’s abstract online.