Summary: how to choose breast implants is a decision made with measurements, not with cup sizes. The width of your breast base, the amount and elasticity of your skin, the breast tissue you already have and the shape of your chest determine which volume, profile, plane and incision make sense in your case. The same implant looks different on two different bodies.
An implant that looks harmonious on another woman may not be a good choice for you. It’s the sentence I open almost every augmentation consultation with, because most patients arrive with a photograph and a number in mind.
This article is what I explain during an evaluation when someone asks me how to choose breast implants. You won’t find a recommended size here, because that number doesn’t exist outside your body. You’ll find the criteria behind each of the five decisions the choice is made of: volume, shape, profile, plane and incision.
How to Choose Breast Implants: Start With Your Measurements
The choice begins with a measuring tape.
During the evaluation I measure the width of your breast base, the distance between the inner and outer border of the breast. That measurement governs all the others, because an implant wider than your base shifts toward the sternum or pushes the tissues until its edge becomes visible.
Then I assess how much tissue covers you. It’s checked by pinching the skin and breast tissue at the upper pole: if your coverage is thin, the implant will show through more, and that conditions the plane and the type of filling. I also evaluate the elasticity of your skin, the position of the nipple, the height of the inframammary fold and the shape of your chest, because a wide rib cage or a marked curvature changes how the volume distributes.
And we talk about your asymmetry. Almost every woman has one breast somewhat different from the other, and sometimes a difference between the two sides of the chest as well. It can sometimes be improved during surgery by using implants of different volume on each side.
Your height, the width of your shoulders and your overall silhouette are part of the same equation. That’s why the number of cubic centimeters, on its own, says very little.
Volume: Why Cubic Centimeters Are Misleading
A 300 cc implant on a woman with a narrow chest and thin coverage looks large. The same implant on a woman with broad shoulders and good breast tissue looks discreet. The figure is identical; the result is not.
That’s why in consultation I work with measurements before I work with cubic centimeters.
There’s a limit worth understanding: the capacity of your tissues. An implant too large for the skin and breast tissue available increases tension on the coverage, makes edges and rippling more visible, accelerates the descent of the breast over the years, and raises the likelihood that you’ll need revision surgery. In many patients a moderate volume gives a more stable shape and holds up better over time.
Photographs help me understand what you like. They don’t work as a promise of replication, because they show a different starting point. If you want to get real value from them, I’d suggest reading how to read a before-and-after gallery first: it changes the way you look at them.
The most useful question you can bring to the consultation isn’t what size you want. It’s what proportion you want to have in clothes, what bothers you about your silhouette today, and how far you want the change to show.
Shape and Profile
Implants can be round or anatomical, also called teardrop. It’s the comparison that circulates most online and the one that creates the most expectations, so I’ve covered it fully in a separate article: round or anatomical implants, what the evidence shows.
The short version, so you don’t have to leave this page: comparative studies haven’t shown that an observer can reliably tell a result with an anatomical implant from one with a round implant. Naturalness depends far more on your coverage, the plane, and getting the size right than on the silhouette of the implant itself.
Where a good deal is decided is the profile, which describes how far the implant projects forward relative to its base. A low profile spreads the same volume over a wider base; a high or extra-high profile concentrates it in less width and projects more.
The logic here is geometric. If your breast base is narrow and you want volume, you need a higher profile, because an implant with a wide base won’t fit you.
Plane: In Front of or Behind the Pectoral Muscle
The implant can sit above the pectoral muscle, below it, or in a mixed arrangement where the muscle covers the upper pole and the breast tissue covers the lower one.
The retromuscular position adds an extra layer of coverage at the upper pole, which is exactly where an implant shows when there’s little breast tissue. It’s usually the choice when the tissue pinch in that area is thin. In exchange, the initial recovery is more uncomfortable, because a muscle has been operated on, and animation can appear: the implant moves or distorts when you contract the pectoral. If you train with weights regularly or do pushing sports, that weighs on the decision.
The subglandular position avoids that animation and gives a more comfortable initial recovery, but it requires that you have enough coverage. Over thin tissues, it leaves edges and rippling more visible.
There’s no fashionable plane that suits everyone. It’s a decision that comes out of your tissue pinch, your physical activity and the shape you’re after.
The Incision: Where Your Scar Will Be
There are three common approaches, and each leaves the scar in a different place.
The inframammary, in the fold beneath the breast. It gives the best direct control of the surgical pocket and of the position of the fold, and the scar stays hidden under the breast. It can be visible when lying down or raising your arms.
The areolar, at the border of the areola, hides the scar well when the border has good contrast, but it crosses breast tissue and ducts, which can affect breastfeeding.
The axillary leaves the breast without scars, at the cost of less direct access and a scar that’s visible when you raise your arm.
If you’re planning pregnancies and breastfeeding, tell me before we decide the approach: having implants doesn’t prevent nursing, but the incision is worth choosing with that in mind.
Surface and Filling
Implants filled with cohesive silicone gel are the current standard in cosmetic surgery for their consistency and feel. Saline implants exist, but they have more tendency to rippling and a different feel to the touch.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon lymphoma, not a breast cancer. What matters for your decision is this: according to the American Society of Plastic Surgeons, it has occurred in patients with textured-surface implants. Estimates of incidence range from 1 in 3,817 patients to 1 in 30,000, depending on the series. In 2019, at the FDA’s request, Allergan withdrew its BIOCELL textured implants, the most heavily textured ones, from the global market.
There’s also breast implant-associated squamous cell carcinoma (BIA-SCC), on which the FDA issued a safety communication. It’s far rarer — 19 cases were documented in the medical literature through January 2023 — and it’s been reported with both smooth and textured implants. The FDA doesn’t recommend removing implants in patients without symptoms.
I tell you this because it’s part of an informed decision and because I’d rather you hear it from me. If you already have implants and what concerns you is when to check or replace them, I cover that fully in when breast implants should be replaced, where I also discuss the systemic symptoms some patients associate with their implants.
Follow-Up After Surgery
On imaging follow-up, the FDA recommends screening with ultrasound or MRI five to six years after surgery, and every two to three years after that, because the rupture of a silicone implant is usually silent and gives no symptoms. MRI is the most sensitive method; ultrasound is an acceptable alternative in patients without symptoms.
Keep the implant card we give you at surgery. When you need a replacement, knowing exactly which implant, brand and size you have makes a difference.
Safety, Candidacy and Expectations
Before we talk about implants, I confirm that you’re a candidate. I review medical history, medications and anticoagulants, family and personal history of breast disease, and your imaging studies according to your age.
Tobacco, vaping and alcohol alter circulation and compromise healing.
I also ask about your plans: a later pregnancy or significant weight loss changes the breast and can change the result we achieve. Knowing it beforehand changes what I recommend.
The risks you should know about include bleeding, infection, temporary or permanent changes in sensation, scars that heal unfavorably, capsular contracture, residual asymmetry, visible rippling, rupture, and the possibility of needing revision surgery.
On recovery: the first weeks bring swelling, pressure across the chest, and restrictions on lifting and training. The definitive shape appears once the tissues settle, and that takes roughly three months.
Frequently Asked Questions
How do I choose breast implants if I don’t know what size I want?
The choice is made with measurements and by reviewing some photographs.
How many cubic centimeters equal a bra size?
There’s no equivalence. Sizes vary between brands, and the same volume looks different depending on your chest and your coverage.
Round or anatomical?
The comparative evidence doesn’t support that anatomical implants look more natural in a reliable way. I cover it in detail in the article dedicated to that comparison.
In front of or behind the muscle?
It depends on how much tissue covers your upper pole and on your physical activity. With thin coverage, the retromuscular plane protects the result; with good coverage and weight training, the subglandular one can make more sense.
How often should I be checked after surgery?
Clinical follow-up according to the plan I give you, and imaging follow-up with ultrasound or MRI five to six years after surgery, then every two to three years, following the FDA recommendation.
Will I be able to breastfeed afterward?
Having implants doesn’t prevent nursing. The incision approach matters, so it helps if you tell me about your pregnancy plans before we decide it.
Do implants last a lifetime?
They aren’t considered lifetime devices. That doesn’t mean replacing them every set number of years without a reason; it means a revision may be needed at some point. I explain it fully in the article on when to replace them.
Before You Decide
Choosing breast implants with criteria means giving yourself the time to understand why each thing is recommended in your particular case, and arriving at surgery knowing what you expect and what you don’t.
If you’re at that point, book an evaluation. We measure and review what’s reasonable with your tissues. You may leave with a recommendation different from the one you had in mind, and that’s usually a good sign.
Sources This content is for informational purposes and does not replace an in-person medical evaluation.
