Cosmetic Surgery Blog

So you’re thinking to yourself, “I’m paying a lot of money so I might as well get my money’s worth and get them big as possible”, right? Well, don’t. You’ll eventually wind up miserable and in need of reconstruction. Been there, done that.

Or maybe you’re a hapless victim of your implanted friends priming you up for a bad case of boobie greed. They may say that they regret not going larger, but ask them why? Do you think theirs are too small? Or do you think they look like pin-up cartoons? Not that there’s anything wrong with that but you gotta wear ‘em, not them.

Let me mention first that if you are getting large breast implants because you feel that they will enhance your career (entertainment industry, etc.), this article will not apply to you. Unless, you choose to explant and will subsequently need a breast lift and other forms of reconstruction, of course. So, if you are the aforementioned “special needs” patient, then you can just read this for entertainment purposes. This article is for the every day breast enlargement varieties. But, if you fit the average breast augmentation patient category (not that any one of us is ‘average, but you know what I mean), then I suggest that you go with what looks good on your own body, and not getting more cup for your buck.

Now, large is certainly a relative term. What is large on me may be small on others and vice versa. I was an F cup, plus with weight gain and birth control pills I snuck up to a G. I normally teeter back and forth between 116 and 117 lb when I am off of the pill and at my normal weight and I have a small frame. That’s TOO BIG for me. Your goal should be a balanced overall look and choosing a size you can comfortably live with will take some consideration. How to do this? I’m glad you asked, because I was going to go on my rant anyway…

1. Frame Size: Are you small, medium, large, or inbetween-boned? Can you pull off a bigger-than-normal rack or are you setting your size standards too high? If you are a tiny person, very large breasts are going to get a lot of attention, and not all of it the good kind of attention. The fact that you’ve got the proverbial boobjob going on will be very obvious and since many men have no social skills whatsoever, well, they’re gonna stare and some will make inappropriate comments.

Remember, balance is your goal. A good hip-to-breast ratio is something to think about if that’s what you want. If an hourglass form is what you’re after, be sure to get them large enough, but not too large, to create this look. Measure your hips and waist, if you want to be within 9 to10 inches of your waist size then consider this measurement. For instance, with implants I was 36-24-36 (how I pulled that off was part luck and a stroke of surgical genius, but whatever. But if following a 10-inch ratio, I could “get away” with having a 26” waist and still have the pin-up look going on. However, these days a 9 inch ratio is considered hourglass. Presently, without implants and don’t laugh, I am 23-24-36 equalizing a 0.67 waist/hip ratio. But for some reason my breasts look larger than my waist so it isn’t as pear-ish as you might imagine. *OMG I need implants again!! HAHA!!* If your waist is thicker than your hip size, you won’t get the hourglass look.

Board Certified Plastic Surgeon, Chia Chi Kao, M.D. recommends going with an implant with a base diameter as wide as measured from the medial cleavage line to the anterior axillary line. If you have a thicker midsection, liposuction to the waistline can give you a more pleasing shape. Don’t try to do it all (getting the hour glass look) with just the implant. You will end up looking matronly. Have you ever notice that a mountain peak looks a lot taller when it is next to a valley? Most guys are not very sophisticated. They think bigger is better. If you took a picture of a nude model and just cut out the breasts by themselves. It is just a nipple on a mound, not very exciting. But when presented alongside a shapely shoulder and a narrow waist…it is very sexy. So ladies, it is not the absolute volume (or cup size) of the mound. It is how the breast accents the waistline- the female form. Almost all of the Victoria Secret models have B cup breasts (Some small C cups) and they are beautiful because the waistline is so skinny.

2. Physiology: How much pre-existing breast tissue do you have? Are you going over or under the muscle? Do you have thin skin? If you have thin skin and you plant some bigguns in there, even if you wear a bra most of the time you’re going to sag faster, thin your skin out even more will need a lift faster than you would have if you’d gone smaller. If you have very little natural breast tissue, hiding breast implants will be a problem and contour irregularities will be an issue. Going under the muscle will help but still, consider your elasticity and your pre-existing breast tissue. I have thin, not so elastic skin due to all the stretching from my large implants. Because of this reason, when I re-implant I will more than likely get full unders which includes not only the pectoral muscles but the serratus fascia and serratus muscles, as well. Dr. Kao advises that one of the downsides of the going under the muscle is that the breasts may seem to “jump” as you move or exercise. Just go to the gym and check out the girls who are obviously augmented and watch as they do the bench press, flys or push-ups. This is caused by the compression of the implant by the pectoral muscle.

3. Lifestyle: What are your hobbies? What you do for a living? Will having larger breast implants have a negative impact on your life? I have many hobbies including skydiving, scuba diving, mountain biking, horseback riding, golf, and more. I can tell you that you will notice the difference if the size change is considerable. I notice it mostly with horseback riding no matter which sports bra I use. It’s not too big of a deal, pardon the pun, but for instance if you rock climb or perform ballet, it will make a difference and you will have to adjust. Regarding your career, If you are a serious businesswoman who cannot hide large breast implants under a suit, you can bet your bottom that your colleagues will notice—and gossip. So if you are a CEO and can fire at will, it’s food for thought. Other than that, transition slowly and start wearing padded bras or silicone enhancers, then after implantation save the low-cut tops for the weekend.

4. Psychological Effects: If you are shy and get offended by men (and women!) shamelessly staring at your breasts like I do, you will have issues with it at least at one point in your life. I got sick of men staring at my chest and not my face while conversing, but my breast were pretty significant. When I got explanted I felt I could rob a bank and no one would notice, I was practically invisible and it rocked! And people stopped asking if I was a dancer or an actress. One guy actually asked if I rode horses professionally during a conversation about horse property. I shook his hand and thanked him excitedly while shaking my head no!

I also want to mention the thin-issue again because it was a main factor in my decision to explant. So many people thought I was heavier in photos because they didn’t see me in 3-D and realize I was just thin with huge breasts. In a poll In conducted on BreastImplants4You.com & Breast Reduction4You.com, I found that the number one reason most women regretted having large breasts (other than premature sag and discomfort) is that they felt heavier, or “fat”. Seriously. Bigger breasts may make one appear heavier than they really are. After my explant I looked so much thinner.

Dr. Kao advised that 90% of the breast augmentation patients in his practice request a 2-cup size change. The most commonly requested sizes is a mid to large C cup. The remaining 10% request a D-cup. Dr. Kao advised that he is suggests to his patients that they stay within a size range resulting in a balanced physique. One should always take into consideration the height of the patient, her shoulder width and the waistline. Also, it is very critical to consider (and not very many Plastic Surgeons emphasize this) is the location of the infra-mammary fold (IMF) as it relates to the waistline. A woman may be petite but has a low IMF and a wide chest wall, can accommodate a larger implant than a tall thin woman who has a very narrow chest wall and a very high IMF. He stated that the larger the breast implant size, the larger its diameter. To accommodate the larger diameter implant, the infra-mammary fold must be lowered which does two things. 1.) It can make the nipple become too high on the mound (the nipples are sitting too high and the mound looks bottomed out) 2.) Lowering the IMF in turn cuts into the waistline. While this may appear attractive while the patient is nude, with clothing, especially a non-fitting garment such as a business suit, the patient will appear to have a shorter waist and also look heavier.

Dr. Kao warns us to beware of Plastic Surgeons telling you that you don’t need a lift, and that he/she can accomplish a “lift” of the nipple by implants (a larger implant) alone. My first surgeon did this and Dr. kao corrected this by successfully raising my fold in my last surgery. What is being done is that the implant is placed lower on the patient’s body (lowering the IMF) so the nipple will end up being centered to the new mound. The location of the droopy nipple is dictating where the implant should be placed. This usually results in an unhappy patient. Dr. Kao really believes that the secret to natural and beautiful breast enhancement is to preserve the natural IMF and choosing an implant with the proper diameter to reach and fill the upper pole of the breast and expands the width of the chest wall to give some lateral fullness. The nipples are adjusted accordingly to the new mound (with a circum-areolar breast lift). The reader must understand that many Plastic Surgeons are hesitant to do a Benelli mastopexy for they are very tricky to do. I have had several of these lifts fail on me, however Dr. Kao successfully performed my last Benelli lift after my explantation and I have had no stretching of the areola or incision lines. The compromise is to do it all with a larger implant or come to terms with a inverted T scar. Dr. Kao believes that the ability to perform a beautiful circumareolar mastopexy (Benelli), that is, with out excessive skin puckering, distortion of the shape and size of the areolar complex, flattening of the mound, and maintaining a thin scar is paramount. Dr. Kao also commented that he felt that without a question, silicone breast implants were far superior to saline breast implants and that he recommends them over saline in the right patient.

Recently, I asked patients on BreastImplants4You.com if they wish they went larger and it actually was a mixed bag of responses. Mostly were very satisfied and more women regretted they had gone too large than I had expected. Interestingly, five years ago I had conducted the same poll and many women had wished they had gone bigger. They must be preparing for the disappointment factor by going larger than they think they will want in the first place because the numbers are showing otherwise. Or maybe women are simply more educated, and experience better communication with their surgeon. Whatever the case, it’s working.

Many of these women are mothers, and younger ladies not blessed with the size they desire. Regardless, whatever breast size they chose and for whatever reason, most patients polled felt that their procedure enhanced their self-esteem, and allowed them to feel more comfortable within their own flesh. I say kudos to anything that can do that. Whatever enhances your life without harming others, I say go for it. Life is too short.