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Breast Implant Size and Overfilling

Possibly the toughest decision after you have decided to get a breast augmentation is deciding what breast implant size to get. For many women, regret over what size they chose is a chief cause of revision surgeries.  But an experienced board-certified breast augmentation surgeon and good communication (as well as realistic expectations) you can get results you will be happy with.

You would think breast implant sizing would be easy, that you could just ask for B cups, or C cups, or what have you. But breast implants do not come in cup sizes. They come in sizes determined by how many cubic centimeters (ccs) they hold (or will hold in the case of saline breast implants). A cubic centimeter is a metric measurement of volume or capacity. (It is also equal to a milliliter, which is the measurement of volume most commonly used in everything medical.)

The amount of breast you have to begin with makes a big difference, which makes sense. If you are an A cup to start with you need a larger implant than a woman who started with B cups if you both want to end up with same cup size. The size of your ribcage and chest wall also make a difference. You can take three women who are getting the same size breast implant and end up with three different cups sizes afterward.

Profile plays a large role, as does whether the breast implants are round or contoured. A high profile implant with the same number of cubic centimeters stands out from the chest further than a medium or low profile implant of the same size.

There are several ways to help determine what size breast implants will look best for you. None of them are perfect, however.

A report at an American Society of Plastic Surgeons meeting found that an average of 189 cc of saline was needed to bring a patient up one cup size. Some surgeons have their own systems for breast implant sizing. Most surgeons who have a lot of experience use that experience in guiding them on what will look best for a given individual and in helping you determine what you want.

The Rice Test for Breast Implant Sizing

Although not the best way measure breast implant sizing, many women use this test to get a rough approximation of the breast implant size they want.  First, you need to get a bra with cups in the postoperative size you want. Then you need uncooked rice (or water, birdseed, or couscous), and a few Ziploc bags. Some women put the rice in the toe of old stockings instead of Ziploc bags because it is more comfortable, more moldable, and quieter. Some women use raw oatmeal, but that might not be heavy enough to simulate a breast implant.

To get an idea of breast implant sizing, fill the Ziploc bags with the raw rice or whatever you are using. Start with two bags of about half a cup of rice each and place them in your bra. Wear them around for a while. Try some clothes on to see you look. Do what you normally do in a given day so that you can see how this size breast implant will fit your lifestyle. Sleep with the bra and rice, too, especially if you are going for a larger size. Breast implants make a difference in whether you are comfortable sleeping on your stomach! Experiment by adding more rice to the bags and wear each size around for a while so that you get a good idea of what you want.

The general consensus with this system is that there is between 270 to 275 cc per cup of raw rice. A cup of water is equal to 236.6 cc. One liquid ounce is 29.6 cc. Metrically, 1 milliliter (ml) = 1 cc, so you can use a metric measuring cup if you want.

Using little bags of rice will give you a rough estimate, and it may be a very rough estimate, or what breast implant size will make you happy.

My advice? Discuss this with your surgeon. Be warned that your surgeon may have never even heard of the rice test. All surgeons are going to be different!

Breast Implant Sizing at Your Surgeon's Office

Cosmetic plastic surgeons who specialize in breast augmentation usually have a set of special implants that they use to help clients decide on breast implant size. Sizers can help both you and your doctor visualize the postoperative size more clearly. Remember, communication is key!  Bring in pictures from magazines or of other women, bring in a bra of the size that you want, and talk, talk, talk with your surgeon about what you want and how you want to look.

To get an idea of breast implant sizing, you can use the sizers by wearing them in either a surgical bra or a sports bra. Then put on a sweater or fitted shirt and either take photos or look at yourself in the in the mirror and see what you think. Again, walk around for a while to see how you feel in them and how you look.

Your Breast Implant Surgery Expectations

Remember, you will be swollen for a few weeks after your surgery. After the swelling subsides, you may be disappointed with the real size, even though it is the size that you and your surgeon discussed. Many women think that they have shrunk dramatically after the swelling resolves. Take before-and-after photos or try to fit in a bra you wore preoperatively, and it will become apparent that you are bigger than you think you are.

Just be sure you understand that your breast implants will have to completely heal and drop and settle in before you can get an idea of what size you really are.Whatever the case, the most often uttered words after breast augmentation surgery is "I should have gone bigger."

Overfilling Breast Implants

Overfilling breast implants is an issue only with saline implants. It is a controversial subject because there is a debate as to whether it should be done at all and there is some confusion on exactly what constitutes overfilling in the first place. Silicone implants are filled at the factory and cannot be adjusted in size.

Saline breast implants are usually put in place empty. They are then filled with sterile saline by your surgeon. Each breast implant has an optimum fill level, which is the amount of saline (in cc) that it should hold, but this level is a range. An implant may have an optimum fill range of 250 to 270 cc, or it may be expressed as 250 + 25 cc. (To give you an idea of how much fluid we are talking about, a kitchen tablespoon measure is 15 cc.)

Overfilling breast implants is the practice of adding more saline than the highest level of the optimum fill range. Many women with breast implants will say they are overfilled when the amount of saline is over the lowest number in the optimum fill range.  They may say "I have such-and-such implants, size 450, overfilled 40 cc to 490 cc." In reality, they are overfilled only 10 cc because 480 cc is the maximum for that implant.  So when you discuss overfill with someone, find out the breast implant size and the full cc amount and then do your calculations.

I had smooth round, size 480 implants that were filled to 510 cc on the left (I really liked my left) and only to 485 cc on my right. I disliked my right. My right was squishy and didn't have the upper pole fullness (roundness at the top of the breast) like my left breast, which was firm and solid.  But I needed those fill levels due to a major asymmetry. I have since upgraded to high-profile breast implants and chose 465-cc models, which are filled to 520 cc on each side. The maximum recommended fill for these implants is 505 cc, and therefore I am overfilled by 15 cc.

Be advised that many women are walking around with implants that are filled past the recommended amount. Overfilling breast implants is done to prevent rippling. It will not make you look like you have larger implants or make your breasts look larger. It can make your breast feel firmer.

If you are interested in saline breast implants, ask your surgeon at the consultation if he or she overfills above the optimum fill range. Remember, your needs will be different than the previous patient’s or next patient's. 

This leads us to the question, “If the manufacturer’s have provided an optimal fill range, why go beyond that?” Breast implant manufacturers are limited by the U.S. Food and Drug Administration (FDA) in what they can say about their implants. The amount of fill that was given originally has been found by many surgeons to be slightly too low and too prone to wrinkling or rippling. But in order to get the FDA to approve new fill levels, implant makers would have to conduct several years worth of tests that would cost several million dollars. However, despite this lack of official sanctioning of overfill, licensed surgeons are allowed to do what they feel is good medical practice with an implant, and fill it up over the top of the optimum range.

Overfilling breast implants is actually beneficial, according to many surgeons. Underfilled implants (which is to say, those filled to less than the top or even the top of the approved optimum range) are prone to rippling. Each time you breathe or move your chest muscles, your implants move slightly and those ripples and folds are stress lines where the implant can fail due to these continuous movements. Overfilling reduces the ripples and therefore eliminates stress lines.

Custom Breast Implants

Some of you may wish to have very large, custom breast implants. Women who are in the entertainment industry are generally the ones interesting in extremely large implants, although other women might want them as well. Either way, custom breast implants are expensive. Adding to the expense, you have to buy three implants so that you have a spare in case something happens to one intraoperatively or postoperatively.

Surgeon fees are usually very expensive with custom breast implants, as well. Having larger than usual implants increases your risks. Finding a surgeon who will insert custom breast implants is definitely more difficult. There are a few around Los Angeles and New York, as well as Las Vegas, Dallas, and Miami. You have to order the implants yourself and you may have to order them from outside of the United States. They will be delivered to you because they will not be FDA-approved medical devices and it is unlawful for the surgeon to supply them to you. You bring the implants in with you and the cosmetic plastic surgeon merely implants them.

Down the line, sagging will be a definite issue with very large implants.  Once you get them, you should wear a bra as often as possible to keep your breasts from sagging and stretching.

"I Should Have Gone Bigger"

The number one reason for revision surgery for breast augmentation is because the patient wants to go up another size. This does not mean that you should go bigger than you want to originally; it just means you should make sure you want those 390-cc implants and not the 425-cc ones. Make sure you know what you want.

If you have expandable breast implants, it is easy to go a bit larger. If your implants cannot be filled more or you are at your max for overfill and don't want to compromise the look and feel, you can always have a second surgery and have your implants removed and new ones put it. Having breast implants replaced is not as painful as having them put in the first time. The trauma from the initial breast augmentation was from making that initial pocket. My second breast augmentation surgery was really easy.