Americans love to supersize. 
Big cars, Supersized fries, the super big gulp. But bigger is not better when it comes to breast implants.
I answered a question from a patient who had been an AA her whole life. She was teased and felt self conscious. So she decided to do breast augmentation. Her surgeon (not me, but easily could have been) told her he would not do a breast augmentation to make her a DD or larger. She was “shocked.” “Lots of women get breast implants WAY bigger than a DD, so why am I being told me request is unreasonable?”
Hmmm. I can understand her frustration. Implants cost the same, regardless of size…. If I get a 500cc implant instead of a 300cc one, I got 200 cc more for the same cost. Woo hoo, eh? This is my body, and if I want a DD, then I will get one! Hmmm. She can go to another surgeon. I’m sure she’ll find someone who will do it. But I think she is bothered by this because the surgeon she saw seems principled and experienced. She knows he is right.
Why would a doctor talk her out of a big size?
Many of us see our long term results years down the road. It does change the way we do things, and how we advise our patients
1. When you are thin, you have thin tissue cover over the breast implant. My skinny athletic Northern California women don’t have much padding. Whatever padding you start with gets thinner over time, as the weight and width of the breast implant thins it more. What does this mean in English? It means as your soft tissue padding thins, you will droop, potentially bottom out, and see wrinkling and other implant abnormalities.
2. If you go to a super large size, even if I put you in the narrowest implant, a high profile, it will be too wide for your chest. What does this mean? It means you will hit your breast when doing any movements along your side, like golf and tennis (what is the handicap for that?). It means your tissue on the side of your breast thins, and you will look round, shiny skinned, and again will see wrinkling.
3. The weight of the implant will cause you to droop. The implants come as cc measurements. The cc’s tells you the number of grams the implant weighs. Simple science: The heavier the implant, the more it weighs, the more you will droop with time. (Unless you live on the moon.)
4. The weight of the implant can cause back and neck pain, shoulder notching (where your bra straps go), and poor posture. See the issues large breasted women get, and why women who are a D, DD, on up come in droves to get lifts and reductions.
5. They will look bad. Unnatural. Round. Fake. Not pretty at all.
6. If you think you want it that large, wear it around for a while. This is more girlfriend’s advice, not a plastic surgeon’s, but do you want that kind of attention? Always? Try to jog. Try on shirts which button up. Try to have a conversation with eye contact.
I am not a Pam Anderson kind of doctor. My patients like people to look them in the face, and listen to what they say when they talk. (Oooh. Those ladies with thoughts and ideas…) I know. That was a horrible generalization. But I don’t see many women like this who want to be a DD or larger.
At least not at this point.
I do see many of these oversized implants down the road. Large, thin skinned, brassy, round. Droopy. Back pain. And NOW they want to downsize. This is now a much harder problem. Lifts are difficult when the tissue is too thin. Scars from a lift are much larger than a simple augmentation. And I can’t get the skin to “thicken” again.
So. Take a long term view. Bigger is not always better, particularly in my thin Bay Area patients. Go for a medium size. It’s bigger than what you’ve got. Go for natural, pretty. Go for breasts you can still jog with. And when you wish you were a little fuller on a Saturday night, wear a push up bra, and think how much better your breasts will look at age 60 than if you had blown them out at age 30.