Okay. So you have decided you are going to do a breast augmentation.  One of the choices you need to make is what size?

I often hear “I want it to look natural.”  “I want to be proportional.”  “I want to be a full B / C / I don’t know.”  Great.   You have started to think about it.

My girlfriend guide to plastic surgery for breast implants (ie what I tell my girlfriends):

1. Don’t pick out a cup size.  I am amazed at how women come in wanting a letter cup size.  There is no standard to bra sizing.  What is a 34C at Victoria’s Secret, is not at La Perla, Olga, Maidenform, etc etc.  What you think is a 34C may not be what I think is one.   Focus on what you like when you see it in the mirror.  I am stunned some women go to doctors who tell them they, the doctor, will pick the size.  Given how many times I have found women totally off on what cup size they think they want, I would strongly discourage this.

2. Photos don’t work.  Seeing a photo of a woman who had 300cc implants does not tell you what you will look like.  Every woman is different.  Lovely, unique, fantastic, and different.  Even for a woman of the same height and weight, how broad are your shoulders? Do you have hips? How broad is your chest? Are you muscular? curvy? I have seen a short woman with a 400cc implant look totally proportional, and a taller woman with the same implant look like she needs a new day job.

3. Natural is not a size.  I can make a woman look natural and proportional as an A, B, C, D, or even DD cup.  Natural has to do with the shape of the breast, how it sits, how it moves.  Every surgeon has an aesthetic.  I am natural.  I have patients who, naked in front of their friends, find their friends can’t tell they have implants.  “How do you look so good after 3 kids?”

So, how do you pick?

Try on sizing implants.  The only way  you know what you like is to SEE it on you.  I make all my patients try on sizers with their clothing in the office.  Bring in tons of tight tops, particularly high necked ones (nothing makes you as busty as those form fitting turtlenecks).  If you work out a lot, or swim, bring in those too.  You need to feel comfortable in all of your looks.  Most of us are multi-faceted women – we are atheletes, mothers, girls on a Saturday night, and yes, even surgeons.  You have to feel comfortable in all areas of your world.  And there is no law against wearing a push up bra after you get breast implants if you need a little extra.

The cardinal rule of implants is “you always wish you would have gone bigger.”  I never believed that rule when I first heard it.  But it is true.  One of my patients said “breast implants are like diamond rings, they shrink with time”.   They don’t really shrink (neither do the diamonds), but what shocks you at first won’t shock you after a while. I recommend you try out your new size for a while.  Stuff your bra prior to surgery.  You will get used to seeing yourself with breasts, so if you want to upsize you will do so prior to picking your final size before surgery.  Also, others will get used to seeing you with breasts, so they won’t notice the change, and you’ll see if it stirs up any good (or unwanted)attention.

Bigger is not always better.  If  you have thin skin, are an athelte (particulary the higher impact sports like running), have poor skin tone, are young  and want pregnancies/breast feeding in the future, then consider the pros and cons of size.  This is an area where your surgeon can help guide you.

Size is an important aspect of breast augmentation.  Take your time to decide.  This is one area I will not choose for my patients, but I will educate you to make your best decision.

So you are going to take the plunge. I think it is fantastic.  There is nothing I have done as moving and rewarding as having children.  Pregnancy is hard on the body.  Common changes occur.  Here is a brief overview of some things to do before you get knocked up.

1. Exercise.  A healthy body does better with pregnancy.  A lot of the women I see with great figures after pregnancy had them before pregnancy.  So improve your muscle tone, particularly your core muscles (especially the rectus muscles and oblique muscles which you use to do pilates/the plank/sit ups).

2. Healthy skin.  The “rosy skin” of pregnancy sounds great. And many women do get it.  They also get a lot of pigmentation.  The sun spots, age spots, freckling- call it what you will- worsens with pregnancy.  So prior to pregnancy, try to reverse any skin pigmentation you have.  Hydroquinone and Retin A are great for pigmentation, but they are NOT baby safe.  There are products with Vitamin C and E which are okay while pregnant and breast feeding.  And the key to pigment? SUNSCREEN and the big floppy sun hat. You should apply sunscreen daily.  Try to find a moisturizer or makeup base with sunscreen in it.  When doing activities in the sun, apply sunscreen 20 minutes before going outside, reapply every 45 minutes in water, reapply every 2 hours regardless, and use sunscreen less than a year old.  I am a fan of the clear zinc based sunscreens.  They are mechanical blockers, not chemical, so they are likely less absorbed in the skin.  Very effective and thought to be a little more baby safe.

3. Ideal weight.  You will gain weight with pregnancy.  (Oh my!? shocking.) The amount of weight you gain varies, but the usual recommendation is 25 pounds.  There is a correlation with weight gain and body changes- stretch marks, loose skin, diastasis, and higher post pregnancy weight.  There are studies which link obese children to mothers who were obese before pregnancy.  (The amount of weight gain has been revised to 11-20 pounds for women with a BMI of 30 or more.)

4. Stop smoking.  I could go on for ages on this one.  It affects every body system; increases your chance of heart attacks, stroke, and cancer; along with sun exposure it is the biggest ager of the skin, and does things I can’t fix with products and peels; no surgeon will do a tummy tuck or a breast lift on a smoker, so you might as well stop now; it is expensive; you can’t do it in restaurants; it yellows your teeth.

The health effects on the baby: it lowers the amount of oxygen they get in utero, increases heart rate, and increases rate of miscarriage and low birth weight.  There are other studies indicating after birth these babies have issues with asthma, behaviorial issues, and higher SIDS. For more information go to: http://cerhr.niehs.nih.gov/common/smoking.html.

5. Surgeries. The one surgery I like before pregnancy is liposuction.  If you have a discrete problem area, like “my outer thighs,” or are an exaggerated pear or apple shape, your shape will not improve with pregnancy.  Particularly for those women who are teeny tiny up top and carry all their weight in their thighs/hips, when you put on baby weight it will all go there.  Fast forward: you are now 10 years older and have stretched that skin more, for a longer time, and your skin is older- it won’t bounce back after liposuction like it would at age 25. Skin tone is key to liposuction, and young skin is better.

I do not like to do abdominoplasty (tummy tuck) or breast surgery right before babies.  If your breasts really bother you and you will not have babies for 5-10 years, then it may be worth it to do now. But pregnancy and breast feeding affect the belly and the breast the most.  If you can, wait to fix up those areas until after you have kids.

So,

Exercise. Wear sunscreen. Eat well/be your ideal weight. Don’t smoke.  Sounds simple, eh?

Now go get practicing to have that baby.