I am having a re-op to fix crease scars, & have a MODERATE increase from 1.5 yr BA. Have 225 Mod Plus f/t 230. My breasts are very round & have alot of upper pole fullness. I would like to switch profiles to a Mod profile (250 f/t 275cc) PS wants me to stay with the PLUS profile (I can fit into a Mod). Wont that make the undesirable shape more pronounced? Desire natural, less upper pole, and more fullness on the bottom. What aesthetic difference can I expect to see in terms of shape & size?
Re-op from 230cc Moderate PLUS to 275 Moderate Profile - Aesthetic Difference?
Doctor Answers (9)
Breast Implant Sizing
Yes you are increasing the volume of the implant. BUT, you are also changing the shape---going from a more projecting implant to a less projecting implant. Do you feel that the implants "point" too much? Do you feel that the width of the implant is too small? DIscuss these issues with your plastic surgeon. For the most part, I use high profile implants. Rarely have I heard the patient complain that their implants/breasts "point" too much. Women that are undergoing breast augmentation want larger breasts but not the increase in base diameter. Nobody really wants their breasts in their armpits!
Breast implant sizing
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.
If revisionary surgery is decided upon, it will be 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.
Shape of breast with change in profile and size and fill
It appears that in a thin individual the potential for rippling (visible or palapble) increases with a low fill moderate profile when compared to a fully filled moderate plus profile.
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Switching implants to achieve less "augmentation" and more "natural"
The size difference in the implants is not very much and although you may notice a slight difference. What it sounds like is that you are simply unhappy with the shape of the device, not so much the size. There are a couple of issues that could be at play. Reasons for too much upper pole fullness range from implant shape, to inadequate lower pole skin/pocket, to capsular contracture. Assuming it is truly an implant shape issue, a moderate profile device would give you less projection. Another option is an anatomic contour device which has a tear-drop shape with low profile in the upper pole.
Proper placement needed for more inferior fill (lower fullness)
Generally speaking, when you are changing the implant size roughly 50cc’s the aesthetic difference is not great. Without photos it is hard to determine but you describe excess superior fill and inadequate inferior fill. This could be the result of placement of the prosthesis being a bit too high, without adequate release and lowering of the inframammary fold to the proper nipple to inframammary fold distance.
A 230cc prosthesis is not terribly large and in general, if properly placed, does not cause undo superior fullness (unless you are a very petite person). It sounds like you need open capsulotomies to lower and better place the prosthesis. Either type (moderate plus or moderate) should work just fine. In the saline augmentations that I still perform (approximately 25%), I tend to use a moderate profile of proper base width since doing so allows me a bit more leverage in creating the proper/perfered shape.
Setting yourself up for disappointment?
Assuming you are average height and weight, going from a fill volume of 230 to 275cc will be unlikely to produce a noticeable difference clinically. I am concerned that you might be disappointed by the lack of change. Also of concern, by planning to change your implants from a mod plus to moderate profile, you are making the assumption that the 'roundness' is strictly due to the implant profile.
The cause of your 'roundness' should be ascertained. Unfortunately, there is not enough information to determine what you define as 'roundness' is or what is causing it. If we make the assumption that you have undesirable upper pole fullness, there are many factors that can cause this problem. These factors include thin soft tissues, implant placement over the muscle, insufficient implant pocket dissection, insufficient pectoralis muscle release, capsular contracture, and even implants that are TOO LARGE. Although a 230 cc implant is not a large implant for the average patient, if you were 4' 10" and 90 lbs, it could be too large for you.
Having said that, changing from a mod plus to moderate profile is also be unlikely to change the appearance of 'roundness'; you will have a slightly wider implant but it is still a round implant and the difference in projection is not very significant.
Bottom line: make sure your surgeon knows what you want, and if you decide to go through with it, make sure he/she feels it is something that has a reasonable chance of being achieved with whatever implants are decided upon.
Lawrence Tong MD FACS FRCSC
230cc Moderate PLUS to 275 Moderate Profile - Aesthetic Difference
You did not post any photos so MY guess is you are only increasing the volume by 45 cc's - NOT much. And changing diameter to a wider measurement with slightly less projection is OK But I would not recommend. NEED A PHOTO From MIAMI DR. Darryl J. Blinski, 305 598 0091
A moderate plus implant has more projection than amoderate for the same amount of fluid. You will have less projection with the moderate implant.
Little difference in moderate to plus profiles
Changing breast implants for a 50cc increase is a very small difference, and we feel that you will not find much of a difference between a moderate and a moderate plus profile. To complete revision of your augmentation after just a year and half for such a small change, if any, does not seem worth the risk or effort. Unless the upper roundness is due to a capsule or a poorly positioned implant which will be improved by revision, I would wait out surgery until the implants need replacing.
Best of luck,