I am looking into having a breast augmentation within the next 3 months, but the only potential surgeon I’ve met with so far told me that he would not do the breast augmentation unless I would consider a smaller breast implant size. I was completely shocked by this. My breasts have been extremely small my entire life (AA cups) — I have always had to wear a “training bra” and was teased about this a lot growing up. I want to get DD or larger breast implants. Lots of women get breast implants WAY bigger than DD, so why am I being told my request is unreasonable? How do breast augmentation surgeons decide how big is too big for different people?

A. There are important anatomic considerations for breast implant size

The size of your chest wall, (the dimensions of the boney chest) serves as a starting point to determine what implants may be tolerated. Next, one has to have enough native breast skin that can be stretched to accommodate the implant. If someone has very small breast with minimal skin laxity, it will limit what size implant can be placed under the skin. Other factors such as the amount of existing breast tissue and nipple position also need to be considered.

In general, an inappropriately large sized implant can create a lot of problems for you and your surgeon has the responsibility to inform you properly.