Selecting Your Breast Size
After you determine that breast reduction is for you, your thoughts will turn to, "What size should I be?" Years of carrying around excessively large breasts have warped the perception of most women, and choosing a size can be almost as stressful as deciding to have the surgery.
There are a few things you can do when trying to decide on the postoperative size you would like to be:
· Go bra shopping and look at the various cup sizes in your bra band size. We recommend doing this experiment with Wacoal bras. They have a very solid standard of sizing, over the vanity sizing that Victoria's Secret. We consider Wacoal to be the gold standard in bra sizing and compare all other bras off of their benchmark.
Note that your bra band size does not generally change with breast reduction. It is possible it can if you are wearing the wrong size in order to accomodate your large breasts but the surgery itself does not alter your band circumference.
First, fill the cups with your fist -- this will give you a better idea of what the size actually looks like. Also note that a 32B is not the same in cup volume as a 38B. Look at both of these sizes in the same style to see the size difference in volume between different bra band sizes in the same cup size.
· Look at pictures. You can view hundreds of before and after photos via our Members Only Photo Boards. In looking at photos, try to find women who are the same general size and build that you are. This will make it that much easier to imagine your new breast size. You can also look online at places like http://www.wacoal-america.com, but again we'll warn you not to use Victoria's Secret as a sizing benchmark, as their bras are up-sized to make women think they are larger than they actually are. Great for the general public, but not so great for breast reduction patients.
· Ask your friends and family. It sounds strange, but many of our members have reported great success with simply asking their friends and family what size they are to get a visual feel for what the band and cup sizes actually look like on someone. Once they explained the reason for asking, many ladies were happy to share their sizes. One caveat: Don't let people try to tell you what size you should be. This is a very individual thing and the decision needs to be yours. You will live with it, they won't.
When thinking about size there are a few things you should take into consideration:
· Are you going to be having any more children? If so, remember that many times breast size will increase with pregnancy. For instance, if you were a B cup post-op and had another child, during your pregnancy your breasts might increase to a C cup or larger. Think of the future and what size you want to be after childbearing.
· Gravity happens, as much as we wish it would not. There is nothing we can do about gravity, and it will have an effect on your breasts. As time marches on, will the size you have selected "stand up" to the tests of gravity?
· Hormonal changes affect your breast size and can be caused by many things, including pregnancy, menopause, and birth control pills. Take into account that any of these things could cause your breast size to increase after your surgery.
· Between Sizes
We hear so many members say they are going to ask for a "large B/small C" cup when discussing the size issue. This is a major concern for us, because we hear an almost equal number of members say that they are unhappy after the surgery when requesting an inbetween size such as this.
There is no such bra size as a "large B/small C" or a "large A/small B." It simply does not work. They don't make bras that size, so you are not going to find one.
If you ask for a large B/small C and get it, then you will be spilling out of a B cup and will fit into a C cup. Or worse yet, you will be spilling out of a B cup and not quite fill out a C cup. Make your plastic surgeon's job easier by giving him or her a solid answer to what size cup you would like to be.
· Talking to your Plastic Surgeon and what's really possible
Once you have decided on your breast size, the next step is discussing it with your plastic surgeon. This step is vital to your post-op satisfaction. As the patient, the size that you would like to be should be the size that your doctor makes you if it is possible. Plastic surgery is known for its fine aesthetics, and just as one can decide on the features of a nose or other fine-tuned plastic surgery procedures, you should be able to have your breast and areola sizes the way you prefer them, right? Well, not always, because the anatomy of your breasts may come into play and dictate a larger size. It is your body, and you will live with these results for a long time -- but you also have to take into account the fact that you want your nipples to survive the surgery, and sometimes a smaller size isn't possible without risking your nipples.
Nipples require a blood supply in order to survive. The pedicle (or flap) that remains attached to the nipple contains both arteries and veins. Nipples can die of lack of inflow from the arteries or lack of outflow from compromised venous drainage, or both. There are times when a surgeon has to make a call to preserve more of the pedicle in order to preserve the blood flow to the nipples, which ends up in leaving the breast larger. If he doesn't make this call, the patient may lose the nipple(s).
Sometimes the size a person wants cannot be achieved immediately because of what is going on inside them, which a surgeon has no control over. Some aspects of surgery are unique to a person's body. There are many aspects of a pedicle, not just the length, so a certain size may not be something ANY given surgeon can guarantee. The best surgeons do the best they can, and if your body structure cooperates, you're there. But, of course, you want them to make sure your nipples survive. If a woman is larger than she wanted to be due to a blood supply/pedicle problem, she should be glad her doctor made the decision to protect the nipple and sacrificed some size to acheive that. To remedy the problem, the patient might be able have a touch up after the new blood supply has formed and/or have lipo reduction for further refinement to the size.
If your plastic surgeon refuses to let you have any input on your end result size at all, ask why. Is it because the blood supply to your nipples is going to be at risk? Sometimes the reason will be that the surgeon feels the size you have decided on would not be "proportionate" to your current build. Take that into consideration, but if that is the only reason, remember that in the end, you should have some input as to size. This is another reason to have two to three consults. Not all surgeons are equally skilled, and simply feeling it's not the right size for you isn't enough of a reason for a surgeon to deem it so. It's not their body. A 38 bra band, for example, can have a B cup, a C cup, or a D cup and look just fine. We have many members who successfully have these variances. It's a personal preference and one that you should have a say in. Typically an A cup is not done due to compromises in the blood supply, but B cups and up should all be possible, as long as your anatomy cooperates and your surgeon is well skilled.
A good plastic surgeon should be able to take your decisions and preferences into account. If your plastic surgeon continues to make decisions about what is proportionate for you and you are in disagreement, consider a second opinion. The truth of the matter may just be that this surgeon is not skilled enough to take you to the size you are seeking and is blaming the matter on your proportions, particularly if he's not stating there is a risk of maintaining the blood supply. Additionally, there is no law against being "out of proportion." If you feel you would like a smaller size so that you can have greater freedom from bras and jiggling breast tissue, and to head off future growth, you should be able to have it as long as the health of your nipples is taken into consideration.
In some instances, you might not be able to achieve a smaller size without having a free nipple graft. This has nothing to do with your body's proportions, but rather depends on your notch-to-nipple measurements and general anatomy that a surgeon has no control over. At BreastHealthOnline, we believe that most women can avoid a free nipple graft by choosing a highly skilled plastic surgeon; however, there are times when a free nipple graft is unavoidable due to your notch-to-nipple measurement. If your notch-to-nipple measurement does indicate a free nipple graft in order to achieve your desired size, carefully consider the pros and cons of this procedure before deciding if it is acceptable to you. It may be that being left a size larger and retaining your nipple function is the better choice for you. However, you could choose to have a 2nd reduction later once your pedicle had healed and settled in. Yes, you might have to pay for the 2nd surgery, but it is an option that you could explore based on your size and pedicle/nipple health goals. If being a particular size is more important to you, please be sure that you have thoroughly researched all of your options and that you have the very best plastic surgeon you can find to obtain the best results.