I currently have high profile Silicone Breast Implants as part of Breast reconstruction due to breast cancer. I'm not happy with the projection and will be having revision surgery Sept 8th. What should I choose for my replacement? My surgeon says I could go with the moderate plus or moderate. We are trying to achieve more volume above nipple line and collarbone without going over into armpit area.
Choosing the Right Profile Implants for Revision Surgery?
Doctor Answers 5
Breast implants for revision surgery?
Thank you for the question.
The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used 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 (saline/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.
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The best way to decide is to have a consultation with a board certified plastic surgeon. Moderate plus will keep some projection and provide a wider base( also higher on the chest) for the same volume as the HP.
Which style implant for breast reconstruction
There may be several methods to achieve your goals. If you are satisfied with your crease then a simple exchange with a moderate plus will likely provide you with an improved result. I generally feel the silicone moderate profiles or too flat for most patients. Alternatively if your breast crease is too low (this commonly occurs in breast reconstruction), elevation of the breast crease (inferior capsulorrhaphy) may help give you the upper pole fullness by shifting the implant upwards on the chest wall.
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Choosing breast implants
I have several patients with the same complaints where we are trying to balance projection with upper pole fullness. I am asking these patients to be patient (sorry about the wording) until the Allergan 410's become readily available for reconstructive use. I feel these will be the implant of choice as well as the Mentor version of the anatomical based gel implants. These implants will allow plastic surgeon to tailor the implant more to the need of the patient rather than just the profile.
While the high profile gives a lot of projection, it is narrow and the moderate plus has less projection but is wider, it is up to you and your plastic surgeon to decide how to go about the surgery. Good luck.
Right implants for revision breast surgery
If you feel that your reconstructed breasts have too much projection, then moderate or moderate+ implants may be an appropriate choice. These implants can give you a more fill above the nipple line while providing a less projection. The two implant manufucters label their implant styles differently so make sure you talk to your surgeon about which exact implant and style he/she is planning to use.