My doctor recommends a Silimed 335cc high profile silicone implant (width: 11.8cm, projection: 4.1cm), submuscular placement, when my BWD is around 12.5-13cm. Note the projection is not as much as Mentor/Natrelle brands. I do not have much breast tissue in the centre of my chest, he said that he could carefully dissect closer to the medial border so the implant would create fullness in the centre. Do you think I could get a natural result with the HP, or should I look at moderate with less CCs?
High Profile Implants 1cm Less Than BWD, Will They Look Unnautral or Create a Gap?
Doctor Answers (6)
Breast augmentation questions and cleavage
I'm not sure about some of the advice you've had. The question is to understand the difference between naturalness and appearance.
Your pictures show you are a perfect breast augmentation candidate if that's your desire. The breast envelope is firm, and you have some breast tissue, so there is decent coverage.
Augmentation will highly likely give you cleavage looking at your preop shots. Extra medial dissection will make the implants more visible, and more easily feelable and reduce naturalness of look and feel . I wouldnt advise it.
Naturalness is mostly about implant size choice (the bigger and the higher profile selected, the less natural), plus the natural coverage you have (and you have enough).
So, if you choose a smaller implant you will look more natural. Around 300cc or so as you have been advised looks fine for that. If you want to be bigger, ir more projectiong than that you will look less natural.
On your dimensions in my hands that would be a moderate plus mentor cohesive II choice, a little less projecting than you have been advised.
However, aside from the extra medial dissection advice your other advice seems sound.
High profile implants with the wide chest
In order for an augmentation to look right the implant must be centered under the nipple and fit into the breast hand in glove so that they move and feel as one. When the chest is wide, a high profile implant can accentuate the distance and gap between, so our vote would be for a more moderate profile implant with a broader base.
Best of luck,
Concern about high versus moderate profile implants for a "natural" look
Higher profile implants will provide you with more projection and basically a more "3 dimensional and dynamic" result which is what many women want. They don't have to be so large as to be unflatteringly ostentatious. Moderate profile implants may be more "natural" but they also can be more subtle which can be disappointing for many women.
As Dr. Pousti indicated and what has been my experience, is that "natural" and specific cup sizes mean totally different things to different people. Some women who request natural results will actually be disappointed with natural results as their natural augmented breasts will be too small.
You need to communicate explicitly with your plastic surgeon. Photos can be helpful. Make sure that the two of you are on the same page prior to proceeding with the surgery.
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Cleavage and breast implants
It sounds like your main concern is cleavage and creating cleavage by placing breast implants closer together in the center of the chest. You cannot create cleavage by placing breast implants. Trying to do so by putting the implants closer together is only a recipe for disaster. You are likely to end up with symmastia that is very hard or impossible to correct. Sometimes the illusion of creating cleavage is achieved by moving the nipple position closer to the midline of the body but that is not appropriate for every patient. You can see an example of that in the referenced web page.
The photos of the patient you posted who had surgery actually had a pretty good result given the degree of asymmetry present before surgery. Plastic surgery in general is better now than it was 30 or 40 years ago but we can only do what is possible given what we start with. Surgeons must try to instill realistic expectations in their patients before surgery. If the nipples were re-positioned slightly closer to the midline the result would have looked a bit better but that does not detract from the basically good result of the surgeon in this case.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Will my implants look unnatural?
One of the problems with submuscular placement of implants is the wide cleavage, like you show in the photograph. However, with careful pocket dissection medially, like your surgeon suggests, it is possible to get a more natural cleavage.
You may have some upper pole fullness with a round implant, which can look unnatural. You could consider an anatomically shaped implant as this will give a more natural look.
All the best. Jonathan Staiano
Breast implant sizing
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" 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 press 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.