Most women who book a sizing consultation arrive with a cup size in mind. That is rarely how the decision actually works.

As a board-certified plastic surgeon, I plan implant sizing based off your anatomy first. Your chest measurements, your tissue, how you live in your body shape, what is safe and what looks natural helps guide implant sizing.

The honest answer is that size is a little more complex that the size of the implant. The plan the implant goes, the projection of the implant, and baseline breast anatomy are play a role in size. They lock together for your anatomy.

Why Size Is Anatomy First, Cup Size Second

Cup letters change with bra brand and band size, so they can’t anchor a surgical plan. Tissue-based planning starts with your breast base width, soft-tissue thickness, skin stretch, and how much volume your tissue can comfortably support.

In plain terms, your chest anatomy sets a ceiling. An implant wider than your breast base width will look unnatural and put pressure on tissue that isn’t built for it.

One that’s too narrow can shift, ripple, or leave you wishing you’d gone larger. The goal isn’t to hit a cup size target; it’s to match the implant to your anatomy.

Silicone or Saline: Two Trade-Offs, Not a Winner

Both silicone gel and saline are FDA-approved. Saline is approved at age 18 and older; silicone gel at 22 and older. Here’s how I frame the trade-offs:

  • Silicone gel feels softer and more like breast tissue, which matters more if you have thin soft-tissue coverage. Rupture is often silent, so the FDA recommends ultrasound or magnetic resonance imaging at five to six years and every two to three years after.
  • Saline uses a smaller incision because the shell is filled after placement, and a rupture is obvious because the breast deflates.

Saline implants often can feel very artificial and heavy. They also can obviously ripple in thinner patients. 

I use silicone gel for most of my augmentations because of silicone feels much more authentically like breast tissue. It also feels lighter in the body and very rarely ripples. 

Profile and Shape: How the Same Volume Looks Different

Two implants of the same volume can look very different by profile. Profile is how much an implant projects forward at a given base width:

  • Low profile: wider base, gentler slope, softer fullness on top.
  • Moderate profile: balanced base and projection, the most common choice in my practice.
  • High profile: narrower base, more forward projection, more upper-pole fullness. Think LOUDER.

Round implants are the most common shape today. Form-stable shaped implants hold a teardrop contour but need a longer incision and can shift if they rotate. Textured shells were designed to reduce movement but are most often associated with breast implant-associated anaplastic large cell lymphoma, so I do not use them in my practice.

Incision and Pocket: More Than Where the Scar Lands

The incision and pocket affect more than where the scar lands. They influence capsular contracture risk, breastfeeding considerations, animation, and long-term comfort.

Incision options:

  • Inframammary fold: below the breast in the natural crease, hides under bras and swimwear, gives direct access while staying away from nipple-duct flora. This is my most-used approach.
  • Periareolar: along the lower areola edge, scar blends with the areola border. A 2018 meta-analysis found higher capsular contracture odds than other approaches, and the CDC notes areolar disruption can affect breastfeeding for some patients.
  • Transaxillary: through the underarm, keeps the scar off the breast, performed endoscopically with less direct visualization. This incision is also associated with an increased risk of malposition as well as capsular contracture. I do not perform this approach for these reasons. 

Pocket options:

  • Submuscular or dual-plane: under the pectoralis muscle, more upper-pole coverage, lower capsular contracture rates in most datasets, but you may see animation when you flex.
  • Subfascial: above the muscle but under the fascia, with no pectoralis muscle disruption, sometimes considered for athletic patients. Studies report low capsular-contracture rates, especially when a Motiva implant is used.

I match the incision and pocket to your tissue, your activity, and your goals.

Safety and Longevity

Implants don’t prevent effective mammogram screening, but extra imaging views can be needed. I’ll walk through your implants, pocket, and surveillance plan before surgery, and tell you when a question doesn’t have a clean answer.

How Sizing Actually Works in Our Office

Two tools, one decision:

  • In-office sizers: you try implants in a sports bra so we both see how different volumes look and feel during normal motion.
  • Goal photos: you bring inspiration pictures so I understand the volume, projection, and cleavage you want.

Photos tell me what you like, but they don’t override your anatomy. Your measurements, the implant dimensions, and your goals together give us a plan, not a guess.

Red Flags and When to Call Me

If you’ve already had breast augmentation, please call my team right away for breast-specific symptoms like these:

  • Sudden swelling, hardness, or asymmetry that develops over hours or a few days.
  • Fever, expanding redness, or warmth around the incision.
  • Persistent severe pain that doesn’t improve with your prescribed plan.
  • A new breast swelling, fluid pocket, pain, hardening, lump in the breast or armpit, rash, or skin discoloration late after surgery.

Get emergency care right away (then notify my team) if you notice:

  • Shortness of breath, chest pain, fainting, coughing up blood, or one-sided calf swelling or pain. These can signal a blood clot in the lung or leg and need immediate evaluation.

The other symptoms above can signal infection, hematoma, rupture, or rare late complications. I’d rather you call once for nothing than wait once for something.

Ready to Schedule Your Consultation?

You shouldn’t have to make this decision based on a calculator widget. As a board-certified plastic surgeon in Richmond, my job is to walk you through size, fill, profile, incision, and pocket so the plan fits you, not the other way around.

Schedule a consultation at our Richmond office, and bring your questions, your photos, and your honest goals. We’ll go from there.