“I love my implants, but I wish I went bigger.”

“Worth it but kinda wish I went bigger.” “Love ‘em but wish I went bigger.” Breast augmentation forums, such as RealSelf.com, are filled with comments like these.

After doing thousands of breast augmentation consultations, I’ve identified four reasons that women hold back from choosing the size they really want to be. If you can avoid these traps, you’ll likely be satisfied with your choice after surgery.

Holding back based on concerns that people will “know.”
Some women don’t want others to know they had a breast augmentation, so they choose smaller implants: “I don’t want to look fake.” “I don’t want people to notice.” “I don’t want people to judge me,” they say. They need not worry.

I assure patients that most women look natural and proportional after their breast augmentation surgery and can keep it a secret if they are so inclined. Patients tell me that their most observant friends and family members are often aware that something is different. They ask questions: “Are you just back from vacation?” “New haircut?” “New outfit?” “Are you working out now?” They can’t figure out exactly what has changed.

Choosing implant size by looking at pictures taken at 3 months after surgery or earlier, instead of looking at fully settled breasts.
When post-op photos are not labeled, you don’t know how far along a woman is in the Screen Shot 2016-01-19 at 9.12.18 AMhealing process. If you are looking at online photos taken 3 months or less after surgery, consider this: The implants have not yet settled into their final position. They are pressed up high, like your breasts would be in a push-up bra. They are not fully settled until 9 months post-op, and at that point they often will look smaller than they do at 3 months. You’ll likely be disappointed if you choose your implant size from pictures that were taken three months after surgery.

In general, your breasts look smaller when you are dressed than when you are undressed. So my before and after photo book includes pictures of women 9 months after surgery both unclothed and clothed, in a bra, tank top or blouse.

Making a decision based on cup size.
Our last blog post explained that being proportional doesn’t mean wearing a C cup bra. Click here to read “Can you make me a full C cup?”

Making a decision based on Internet forums and input from friends.
You might like the 375 cc implants you saw online, but are you comparing apples to apples? The woman whose breasts you were admiring might have started out with breasts that were larger or smaller than yours, and she might be a different height and weight, too.

If you’re starting with a full B cup and that woman started with a mid-A, you won’t end up the same size when you both get 375 cc implants. You’ll be about 1-1/2 cup sizes bigger – the extra cup you started with.

Likewise, friends who have implants might weigh in on your choice: “One of my girlfriends who has implants said that the implants I selected are too large for me. She has me second-guessing myself,” a patient told me.

My advice is that after you’ve looked at pictures of women who are similar to you and your frame, and you’ve chosen the size that seems right to you, trust yourself. Go with your gut or your heart – not your head. Remember that you’re the expert for yourself.

Do I have to tell my partner that I have breast implants?

This letter, which appeared in The Philadelphia Inquirer on January 28, 2015, caught my attention. I can’t resist offering my two cents!

Dear Abby,
I have been dating a wonderful man for two years and am in hopes of getting a proposal soon. We are both committed to staying pure before marriage and have not been intimate.

My question to you is: Do I have to tell him, now or ever, that I have had breast implants? I did it several years ago, and it greatly improved my self-esteem. I’m glad I did it.

Since he has never felt any breasts, if I tell him, my fear is he will get hung up on the thought, “I wonder what real breasts feel like.” On the other hand, if I don’t tell him and sometime in the future he finds out, he may be, like, “I can’t believe you kept that from me.”

What would you advise?
Reticent in Kentucky

Dear Reticent,
Many women have breast enhancement surgery so their figures will be more balanced. For the reason you have mentioned, you should tell your boyfriend. It should make no difference to him.

However, if it does, it’s better that you know now before you spend any more time on someone who measures the worth of a woman by how “real” her breasts are.

P.S. If he wants to know what “real” breasts feel like, tell him to go hug his mother.

I agree with Abby. If “Reticient in Kentucky” candidly explains why she chose to get breast implants and her boyfriend can’t be supportive, he’s not the right guy for her. If he truly loves her, he will likely be satisfied with what she has – real or not – if she is happy.

Screen Shot 2015-03-19 at 10.42.38 AMMaybe Reticient can take inspiration from Amanda. She had been with her boyfriend for more than a year and had met him after her augmentation. When he complimented her on her “perfect breasts,” she simply said thank you. He didn’t find out until he looked through one of her old photo albums and saw a picture of her at the beach – before her surgery. He still thought her breasts were perfect.

More than half of my patients bring a partner with them to their consultation. Though the exact words vary, the essence of the communication is that he loves her just the way she is. He doesn’t need her to do this. He’s there to be supportive and will let her know if anything is too crazy. And when the woman chooses her implant size and looks at her partner, she’s thinking, “Can you live with this choice of mine?”

Screen Shot 2015-01-09 at 9.15.34 AMAfter the surgery, many women tell me that their significant other doesn’t notice much of a difference between their natural and augmented breasts – other than the size. That’s because when implants are placed behind the chest muscle, they look and feel natural. When you feel the augmented breast, you are feeling natural breast tissue. When women lie down, their breasts could still fall to the side, like they did before the augmentation.

Most women look natural and proportional after their breast augmentation and can keep it a secret if they are so inclined. Nicole, in her late 40s, didn’t tell her family that she was getting implants. Afterward, she emailed them a photo of herself in a tank top and then called to ask if they noticed anything different. “New hairdo?” her mother said. “Are you working out now?” her father asked. “Keep looking,” she prodded them. After hearing her no responses to her parents’ questions, her brother guessed: “Boob job!”