Written by: Dr. Russel S. Palmer, M.D., P.A.Many times patients come to see me requesting a specific implant size because they have seen a result they like on the internet, or they like the way their friend’s breasts look. While size shopping may be useful in purchasing clothing or shoes, coming into a plastic surgeon’s office with a specific size of breast implant in mind is not usually a good idea. There are many factors which are involved in selecting the proper implant for a patient.One of the most important factors is the physical appearance of the patient. Larger patients usually need larger implants than smaller patients to achieve the same appearance. More petite women usually need smaller implants. Women with wider chests will also usually need larger implants. The surgeon must also take into account the height of the patient and the position of the breast on the chest. Some women have higher breasts than others, which can affect the size selection. Often times patients are asymmetric, and different sizes of implants can be used during surgery.Another factor to be considered is the preoperative status of the women’s breast. Implant size can be limited if there is a short distance from the bottom of the areola to the fold underneath the breast. Patients with bigger breasts preoperatively may need a smaller implant than those with less natural breast tissue. Patients have different amounts of elasticity of their skin, breast tissue, and muscles, and this influences implant size. This factor can only be accurately assessed during surgery, and can definitely change the size of implant.There are many different shapes and styles of breast implants. From one leading implant company, implants come in moderate profile, moderate plus profile, high profile, and ultra high profile. There are several other leading implant companies, all with multiple profiles of implants. The same volume implant in a different profile can produce a very different appearance. Implants also come in round shapes and anatomic shapes. Some are textured, and some are smooth.One practice I disapprove of is “trying on” an implant. Patients will come to my office after seeing another surgeon who places an implant in her bra to show her what size she will need. This is a highly inaccurate method of sizing, as it ignores all the factors I have already mentioned. Furthermore, if it becomes necessary to used a different implant size, the patient might be concerned.In my opinion, there are two main factors in getting the look you want from a breast augmentation. One, clearly communicate to your prospective surgeon the look you are trying to achieve. If you want to be large and round, express that to your surgeon. If you want to be smaller, and someone is pushing you to be larger, select the size you want. Some patients are shy about stating their desires. Second, choose the right surgeon. Make sure he or she is carefully listening to you, has experience doing the operation, and has a great track record. You should leave your consultation with a good feeling about your surgeon, his staff, and their facility.