by Emily Ballew
Updated September 2018
You've wrestled with the size of your implants after breast augmentation, believing you've gone too small. You have regret.
If you're a year out from your breast enhancement and still feel that your breast implants are too small for your body, you should consult board-certified surgeons to discuss breast revision surgery options. Before you go, consider these tips as they are designed to help you avoid choosing the wrong size again and provide insight on what to expect when moving up in implant size.
Are your breast implants really too small? The breast augmentation fake-out effect
If you are less than six months out from your breast augmentation surgery, you could be going through the breast augmentation fake-out effect.
In the first days and weeks into your breast augmentation recovery, you saw many things going on with your breasts—they were riding high and may have had a torpedo effect. As the swelling and bruising subsided, your breast implants appeared to be getting smaller.
You may not realize but it takes several months to a year for your breasts to settle into their proper position and take full shape. And perhaps you've understated or underestimated the time it takes to mentally and emotionally adjust to the size and look of your new bust.
5 tips to avoid choosing the wrong breast implant size—again!
If after six months to a year you still feel you went too conservative the first augmentation, choosing the appropriate size for your second surgery is imperative as it will prevent multiple surgeries down the road, as well as the potential for complications. Consider these tips to getting closer to the size you really want.
1. Close information gaps
Communication is key in any and every relationship, even the one with your surgeon. Unfortunately, he can't read your mind, nor may he have the ability to pull that information out of you. It is therefore imperative you articulate your desires as clearly as possible. And if you have any concerns, raise them quickly and without hesitation.
Tip: Try putting everything into context verbally. Be as specific as possible. Some women find it helpful to start by telling their surgeon what they don't like about their breasts before telling them what they would like. Then, they have their surgeon reiterate that information back to ensure they are on the same page.
2. Be selective about your goal photos
Many women make the mistake of looking at before and after breast augmentation photos, printing them or clipping them, then handing them to the surgeon. "Here, I want these." But how did you field your photo options?
Did you look for women with a similar anatomy to yours? Were they the same height and build? Were their breasts spaced far apart or closer together like yours? Did they have ptosis (sagging breasts) before augmentation? How much of a size increase did they go? If you weren't selective about your goal photos, this could be partially why you ended with your results.
Tip: Finding photos of a woman with your approximate shape and size (both body frame and breast implant size) gives your board-certified plastic surgeon an idea of what you are looking to accomplish. That said, this is not a hard and fast rule, so you'll need extra assurance. This is where communication comes in.
3. Be realistic
The disappointment women have with their post-op size and shape often stems from not having realistic goals from the beginning. A breast augmentation alone will only give you a larger version of you, so to speak. You must additionally understand a breast augmentation's limitations. For instance, a breast augmentation will not fix breast ptosis, or sagging.
Tip: To avoid having unrealistic expectations, you must have a firm understanding of your anatomy—what it can do and can't do. If you know this, you'll be more satisfied with what your natural breasts can really handle and not force them to go out of bounds.
4. Forget cc's and cup size
When making the decision to exchange your breast implants for a larger size, it is best to not have a certain number of cc's or cup size in mind. If a number is your only goal and driving point, you will likely be disappointed and you may find yourself signing up for a revision shortly after your second augmentation.
Tip: If your end result was not what you had expected, discuss your concerns with your surgeon to avoid further dismay after your revision. But more importantly, try on temporary sizers and, if available, get a 3D mockup of what you will look like with different breast implant shapes, sizes, profiles, fills, and placement types. Do this until you find the look that suits your personality and end goal.
5. Understand the limitations of your anatomy
During your consultation with your plastic surgeon, he or she should have taken your breast width diameter (BWD). These measurements, along with other details learned from your physical examination, tell your surgeon how big you can go.
Tip: If your surgeon recommended a range of sizes and you chose one lower than the max cc's he suggested, you'll want to step up but not over that limit. While you can find a surgeon to push the limits of your BWD, you run the risk of bottoming out or symmastia. So, only go as far as your anatomy will allow you.
If you've already reached that threshold, then consider loving the girls you have, but give them an extra boost with push-up bras or a breast lift procedure.
Risks associated with increasing breast implant size
You want larger implants, but are you prepared for potential drawbacks that may occur? Many women aren't. They dislike their size, then go in for revision surgery only to find themselves months and years later with deeper regret. They were dealing with one problem—a size issue—and now they have more.
These are a few risks that could occur when you go up in implant size:
Breast stretch marks
Many women are concerned about breast stretch marks. While stretch marks may occur whether you go up in size or not, getting larger implants will make you more prone to them. With bigger implants, your breast skin and tissue have to stretch in order to cover and support the implant. This could cause dermal scars and tears.
Sagging breasts
Did you have ptosis (breast sag) before your breast augmentation? Do you still have some sag despite more fullness the breast implants provide? If so, adding additional weight will cause your breasts to sag more over time and with aging.
Sagging breasts is not a complication by definition, but more of a common concern among women pre- and post-augmentation. Should it be your concern too, understand that if you get bigger breast implants you are likely to require a breast lift down the road to prevent additional sagging or to correct a lot of sag.
Bottoming out
When an implant slips below the breast pocket created by the surgeon, it's known as bottoming out. It typically occurs in women who have little breast tissue and skin coverage but opt for breast implants too large and heavy for them to hold.
You might find yourself doing well after surgery then, over time, as you age, lose weight, become pregnant, breastfeed, go through menopause, take certain medications, or undergo certain medical treatments that your breast tissue and skin thin, making it possible for your breast implant to slip out of pocket. This may happen with one or both implants.
Symmastia (uniboob)
A good breast implant surgeons will tell their patients what implant size is best for them, but sometimes the patient presses the issue, either making the surgeon concede to giving them the size they want or finding a surgeon who will.
If your breast width diameter cannot fit a certain implant size and you want to go much larger, the surgeon performing your breast enhancement may use a tactic known as over-dissection. This is where the breast pockets are overcut and over-created to allow the pockets to accommodate the much larger implants.
The breasts end up merging together into one larger breast, hence its nickname uniboob.
Necrosis
This is the medical term for tissue death. Necrosis may occur when the blood flow has been restricted to the breast area by implants that are too large and put too much stress on the breast skin, tissue, and nerves. With the blood supply cut off and oxygen lacking, cells can die, causing the tissue to rot from the inside out.
