“What implant is best for me?” is a great question. It is also one of the most frequently asked questions and probably the most important question to answer in order to achieve the best outcome for each individual patient. Each surgeon will have his or her own personal criteria for implant selection.
In my opinion, it is very important to begin the selection process by carefully listening to the patient’s goals and concerns relating to breast enlargement. I find that the great majority of patients want to be made as full as possible without looking artificial. This means an outcome with some, but not excessive, fullness in the upper part of the breast. Many patients will state the cup size they would like to achieve. Although cup size varies from one vendor to the next it helps to begin to understand the general size the patient wants to be and to determine initially, if the goals are realistic. Many patients bring pictures of breast implant outcomes they would like to achieve. Although the final outcome for each patient will be dependent on their preoperative shape and size, photographs are helpful to have a general idea as to the outcome desired by the patient. External sizing implants are also helpful in determining a final breast volume. These are specially made, form fitting implants that are placed into a snug fitting sports bra. A suitable top is then put on. The patient can look in a mirror and provide their opinion of how they look. Many surgeons utilize 3-D imaging. This is new technology that creates a reasonable 3-dimensional picture of how a patient will look after breast augmentation. After a general idea is achieved, chest wall measurements are taken to help refine the selection. Smooth walled silicone filled implants are normally a good choice for breast augmentation as they have a better look and feel and are less likely to show wrinkling. These implant differences are more apparent in patients with less breast tissue to cover the implant. This series of steps usually leads to the preoperative selection of the best implant. One final step can be taken to confirm the selection. After the pocket is created in the operating room an intraoperative sizing implant can be temporarily placed in the pocket. The back of the operating table can then be elevated so that the surgeon can view the patient both laying down and in the sitting position. Occasionally this final refining step will result in a slight change in the preoperative selection and help ensure the best outcome for the patient.