The patient asks if a particular size is appropriate, but more importantly she needs to know the problems a patient faces when the tissues are very thin and there is hardly any fat or breast tissue to cover an implant. This particular situation is the extreme of all the problems women face when they decide on sizes and types of implants. It is the interaction of the implant over time with the elastic holding ability of the overlying skin and breast tissue that determine how much wrinkling and descent of the implant with skin stretch will occur over time. Thin patients will always reveal more of the implant shape, which has a tendency to make the result look too round. This is helped by putting the implant partially under the pectoralis muscle. The larger the implant, the rounder and less natural the result looks with thin skin. The larger the implant, the more the patient is likely to feel and see wrinkling of the implant over time, through the thin skin. A high profile cohesive gel implant holds its shape a little better than a moderate profile round, but in the thin patient the upper pole of the breast tends to show a more abrupt transition between chest and implant, a step-off, so to speak. The moderate profile collapses more, especially as the skin stretches, so the upper pole step-off appearance may be less, but the moderate profile may look and feel more wrinkly. The larger the size, the more these problems become, since size equals weight equals stretch over time. To avoid going too large, the breast diameter must be measured and the implant diameter has to be no larger than this. If 300 fits, then 300 can be used. Another alternative would be a form-stable implant which holds its shape. Although some women feel these are too firm or not round enough for their taste, they seem to hold their position better over time, and since they do not collapse very much, hence the name form-stable, they tend not to be so wrinkly through thin skin. Bottom line, thin skin, little coverage, large implants do not go together well. In this situation, in the interest of long-term maintenance of the integrity of the skin and avoiding stretch, wrinkling and inferior displacement, think smaller rather than larger, or form-stable rather than soft cohesive moderate or high profile gel.