5'5, 127. Tubular breast issue on the right. Also a protruding chest wall. I am a 34A now and am looking for a more full look but not very large. Discussed a smooth round cohesive silicone ~250cc. Doctor said he may use textured to minimize complications if he needs to cut too much on the right. I would like a nature full but sloped look and don't want it overly pronounced on the upper chest. So he told me to consider anatomical but the before/afters I see are not less full on top. Thoughts?
Anatomical Vs. Round for a Protruding Chest Wall? Opinions?
Doctor Answers (16)
Would recommend round implants but not because shaped are not good
Based upon your pictures and description of your chest wall, I would suggest that you consider a soft, round silicone implant as opposed to the shaped implants that are currently available. I make this recommendation for reasons other than what I have read in this thread so far, however. In general I have not found the shaped implants to cause problems; on the contrary, in my hands they give excellent results for the right patients. They aren't for everyone. With proper technique and texturing of the implants I have not found rotation to be much of a problem at all. It is actually very difficult to move the textured implants once they are placed into an appropriately dissected pocket, and any surgeon who does enough of these cases will corroborate that. In addition, the texturing of the implants has caused increased deflations in saline filled anatomical implants, but the currently available silicone shaped implants are filled with cohesive gel, and therefore, than cannot deflate; they are solid. Having said those things, I will also say that because the cohesive gel implants are more solid, they tend to project more in those patients with chest wall irregularity, and they can also project irregularly too, especially if the chest wall shape is irregular. They don't as much of a tendency to "drape" over irregularities. The best implants that I have found for patients with skeletal irregularities of the chest wall are the Mentor smooth round memory gel implants. The shells of these implants are much more supple and "stretchy" than the others I have found, and they conform the best to irregularities. They sort of collapse around the irregularity better than the others. I would also suggest a moderate or moderate plus implant as opposed to high profile, because a high profile implant will be rounder and tend to over project and under conform to your chest wall. Additionally, your breasts are fairly widely spaced, and you would benefit from more base width of the implant as opposed to the rounder, narrower profile of the high profile (and let's not even think about ultrahigh profile!). Lastly, I would keep the volume to a modest range; you should avoid very large implants as those will tend to simply project at the upper pole and accentuate the irregularity and asymmetry that is there. Modest sized implants, especially the Mentors, will "settle" when you are in the upright position, and they will almost become a teardrop shape and produce more modest projection in the upper part of the breast. So to summarize, shaped implants are a great choice for the right patient, but I think that you are better served by round, smooth, Mentor implants. Good luck.
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Round versus shape.
Results are technique dependant
I think you will achieve the results you wish. But rather than focusing on the type of implant profile or the number of cc's or bra cup size (with is inaccurate and manufacturer dependent), I would recommend you communicate very clearly your expectations and desires. Your plastic surgeon will decide with you on the profile of the implant based on the breast width, your body shape, skin elasticity and thickness and native breast tissue present. In my practice I usually explain the implant types, profile and rationale for using different implants/ profiles. I also use the a special sizing system pre-op and have patients try them inside a bra so they can get a sense of their look. I never tell them what size I have picked until they show me the "look" they REALLY desire by trying on the sizing system in our office. Then we sit down and evaluate "the look" they have chosen and see if it matches what I have chosen by measurements and physical exam. It does make it both fun and is a healthier partnership between patients and the PS. Speak with your plastic surgeon.
Either an Anatomical or Smooth Round Implant Would Work
Both implants would give you a nice result. You seem to be picking a small implant so you need to be sure as to what size breast you would like to end up with. With a 250 cc implant you will most likely be a full B or small C cup. You can achieve a natural looking result with either a cohesive or a smooth silicone implant.
Anatomical implants not used much any more
We tend not to use "anatomical" implants any more. The name sounds good, but there is really no practical advantage for these implants, that are shaped more like teardrops. In the human body, their shape turns out to be similar to a round implant shape. A disadvantage is they are often textured. We don't use many textured implants anymore because they seem to have a higher risk of deflation (and they don't really reduce the risk of capsular contracture as once advertised).
I don't think you have a tuberous breast deformity and even if you did, radial incisions have not been shown to be effective. A 250 cc implant size would be too small on you. I would recommend at least 350 cc, using a smooth, round implant style.
Breast implant size/type?
The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size. This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone and low/moderate/high profile), bra manufacturer variance in cup sizes, the degree of filling of the cup with breast tissue, and the subjective differences in patients perceptions of cup size.
Much of the final “look” achieved after breast augmentation surgery depends on several factors: 1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal. 2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant. 3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22. 4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is “I wish I was bigger”. I hope this helps.
Anatomic Breast Implants vs. Round Breast Implants
Anatomic implants can result in complications such as unwanted rotation. In addition, most surgeons who use anatomic implants use the textured ones, which patients tend to feel more and which also have more rippling. I would recommend a smooth round silicone gel implant.
A natural looking breast implant result.
I have written a brief article on "Natural looking breasts" under my profile on Realself. I would call your right breast a constricted but not necessarily tuberous breast. My primary concern is the width of your cleavage which will result in widely separated breast implants if a modest size is used. I would suggest round smooth silicone rather than the anatomic. Textured will keep the implants in place but may feel more rigid than a smooth surfaced implant.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.