Imagine waking up from breast implant surgery and your breasts look bigger—much bigger—than you expected. Is it swelling after surgery or are the implants bigger than you thought? That scenario is making the rounds on TikTok, where a viral clip suggests that nine out of 10 women wake up with implants much larger than they bargained for. Although we can find no statistical data to support this claim, we wanted to investigate. Do surgeons actually upgrade implants, and if so, how often (and why) does it happen?
Featured experts
- Dr. Amy Sprole is a board certified plastic surgeon in Wichita, KS
- Dr. Elie Levine is a board-certified plastic surgeon in New York
- Dr. Ruth Hillelson is a board-certified plastic surgeon in Richmond, Virginia
- Dr. Robert Singer is a board-certified plastic surgeon in La Jolla, CA
Facts-Reputation Check Mill
La Jolla, CA plastic surgeon Robert Singer, MD, offers a clear perspective on the misconception spread on social media. “It’s important to remember that 92 percent of women who had breast augmentation at 10 years are happy they did it. What social media tends to do is amplify stories that are extreme or atypical, creating a false narrative,” he explains.
Dr. Singer also points out that some patients may initially feel that their implants are larger due to swelling or tightness. “This creates an illusion, but it is important to understand that the end result will be more in line with what was planned. It’s not unusual for patients to later say they could have been even bigger.”
The importance of preoperative size
According to Wichita, KS plastic surgeon Amy Sprole, MD, a thorough preoperative process is key to avoiding size-related surprises. The goal, he says, is to give patients a clear picture of their options before they make final decisions. “In my practice, we do a virtual sizing procedure with Crisalix software so patients can see what their body will look like with different implant sizes. We also use physical gauges that patients try on with a bra sizer,” explains Dr. Sprole.
Because the size of the implant can change
Dr. Sprole acknowledges that size adjustments during breast implant surgery, although rare, can occur. “No, it’s not common, but sometimes it’s necessary. For example, if the skin is tighter than expected, it may need to be made smaller,” he says. He adds that a common phenomenon is that patients who have had implants for decades may not always know the size of their existing implants, which can also lead to size adjustments when switching to new implants.
New York plastic surgeon Elie Levine, MD, agrees that adjustments are uncommon, but stresses that doctors don’t make cosmetic sizing choices without reason. “Size rarely adjusts, and when it does, it’s a minimal change,” notes Dr. Levine. He also emphasizes the importance of a thorough preoperative consultation to ensure that patient expectations are aligned with what is possible. “This requires the surgeon—not his staff—to spend valuable time during the consultation,” he says, emphasizing the need for clear communication between patient and surgeon.
“There may be modifications to the patient’s expected size, and we prepare them for that possibility,” adds Dr. Sprole. “However, I try very hard to deliver the implant size that the patient wants.”
Avoiding surprises Post-surgery
While the doctors we spoke to assured us that no implant size changes are made without their patient’s knowledge, the idea that patients often wake up with larger implant sizes isn’t that far-fetched. It happens from time to time. “One would expect this to be a rare phenomenon,” says Dr. Levine. “Many of my patients who come to me to revise work done elsewhere wake up with an implant that’s not even close to the size they expected.”
The key to avoiding this scenario is to be thorough and talk about all the options. Dr. Sprole advises patients to develop a range of acceptable tumors, which allows for some flexibility during surgery if necessary.
Symmetry and natural effects
For Richmond VA plastic surgeon Ruth Hillelson, MD, symmetry and natural appearance are critical factors when choosing an implant. “Breasts need to match the structure of the body, and size symmetry plays a role, especially in breast reconstruction or augmentation,” she says. “Implant sizes may need adjustments during surgery—even right versus left. This should be discussed with the patient prior to surgery. Perhaps the take home lesson from this is that both surgeon and patient should agree to the proposed outcome. In my conversations with my patients, I listen. Always listen.”
Ultimately, while it’s possible for implant sizes to change during surgery, the surgeons we asked agree that the best advice is to be thorough in your visits, communicate clearly with your surgeon, and make sure you’re both on the same page about what is possible. “Find a board-certified provider, preferably trained in cosmetic fellowship, who really spends time trying to understand what you’re looking for from the procedure,” adds Dr. Levine.
Dr. Singer agrees. “Patients who visit plastic surgeons are well prepared before surgery. They consider their options, see illustrations and try on different sizes. When they first wake up, there is some swelling and tightness, but these sensations subside over time and most patients are delighted with their results.’
