Question: What happens if I choose a bigger implant than my surgeon recommends?
-LB

Answer: Dear LB: Choosing an implant that is larger than your natural tissues can accommodate results in stretched out tissues, rippling, and un-natural results. For any given woman, there are only a few optimal sizes available that will give good, long lasting, problem free results. Choosing breast implants outside the optimal range gives poor results in the long term. Although the initial results may be good, the problem is what happens months or years later. Oversized implants cause late complications; in other words, problems arise later on. Despite promoting Opti-Sizing for many years, many doctors still persist in offering patients whatever size they choose, even if it is not in the patients long term interest. In contrast, Opti-Sized patients have good, long lasting results. The benefits show up in studies of long term followups, when patients have had their implants for many years.

Many patients shopping around for the surgeon that will provide the larger implants will eventually find one. From time to time, I see some of these patients back who did go out and find someone to place large implants. Unfortunately, it is difficult to repair the problems arising from this poor choice. I feel sorry for these patients, because they did not really understand the consequences of their decision. Somehow, they believed that I was being paternalistic or misogynist in suggesting a narrow range of sizes for their choice. In fact, I was being a strong patient advocate, because I strongly believe that patients who actually understand the consequences will always choose the Opti-Sized method.

Although I understand the strong emotional desires for larger breasts and although I want to help these women correct the deformities that resulted from their poor choice, it is just not possible to do so in many circumstances. I advise patients that in many ways, going through breast augmentation is kind of like going through a one-way door. Once you have passed through it, it is difficult if not impossible to get back to the beginning. The best thing for you to do is to try to understand the consequences of every decision you make before undergoing this operation.

Breast augmentation is all about trade offs, and everywhere you gain something, you give up something else. Having your priorities in order is very important, because each decision you make means you gain something, and give up something else. Having a clear list of ‘wants’ and ‘don’t wants’ before surgery is a great way of making sure that you get your desired results. I never want to force patients to decide, but I do want my patients to know the reasons choices are made on their behalf. Every single step of breast augmentation has options, and each option has proper reasons.