My Surgeon Says the Implant I Want Is Too Narrow. Is That Real?

So you're interested in a breast augmentation, and your surgeon tells you the implant you want is too narrow. Is that actually a thing, or do they just want you to have bigger breasts?

It's a real thing. Here's what your surgeon is talking about.

The classic teaching in breast augmentation is that the implant should be a similar diameter to your breast. You don't want to choose an implant that's much wider or much narrower than your natural breast, unless you're really trying to change something.

For most patients, the implant should stay close to that width.

Say your breast has a 12 centimeter base diameter, and you choose a much narrower implant at 9.5 centimeters.

Here's the concern: it can start to look tuberous, because it doesn't fit your anatomy. You have a narrow implant projecting forward, and it makes your breast look tubular.

(A tuberous breast is a narrow, tube-shaped breast some women are born with. A too-narrow implant can push a normal breast toward that look.)

In a traditional augmentation, we typically access the implant space through the crease under your breast, which has the fewest complications. That means the implant needs to be tall enough, not just wide enough.

A round implant is as tall as it is wide. So a 9.5 centimeter round implant is also 9.5 centimeters tall. Depending on your nipple-to-crease distance, it may not rise above your nipple and areola very much.

That gives you a lot of volume in the lower part of your breast and not much in the upper part. And with a traditional augmentation, it's difficult to get an implant to sit higher than the crease.

You can certainly do it. It's just often not going to give you that pretty, full look we're going for with a breast augmentation, and it can change the shape of your breast into something kind of strange.

Since I started doing Preservé, I find I don't have to follow those rules as closely.

In a traditional augmentation, we open the space at the crease and work up from there. With Preservé, we're not doing that. We create a little tunnel to wherever we want the implant, and make the space there. So I'm also not making the space the same way.

As long as the implant is small, and we don't think it will cause much lower pole stretch (the implant stretching out the lower part of the breast), I can actually get a smaller implant to sit a bit higher than the crease and stay there. And it tends to look fine.

So if you want a smaller implant, and your breast shape is a good fit for Preservé, it may be worth considering a Preservé augmentation over a traditional one. (Here's more on why targeted placement is such a big change, and on adding upper-pole volume without going bigger.)

I know this can be really frustrating. It's not that we want everyone to have giant implants.

(If you're still working out your size, here's how implant volume relates to cup size.)

• The classic rule is that an implant should be about as wide as your breast
• A much narrower implant can make the breast look tuberous
• A narrow round implant is also short, so in a traditional augmentation it can fill the lower breast and leave the upper breast flat
• With Preservé, a small implant can sit higher than the crease, so the width rule matters less for the right patient
• When your surgeon pushes back on a narrow implant, it's about fit, not about making you bigger