Would You Advise For/against 350cc High Profile Implants for This Petite Mother of 2? (photo)

If you are set on the 350cc volume for your breast implants then you don’t have much of a choice and will have to use a high profile (HP) implant. Given your small frame and narrow base diameter, a HP implant is your only option if you want a significant volume for your augmentation. I use biodimensional planning for implant selection, and try to keep the implant base diameter within 1cm of the breast base width. At the 350cc volume you desire, a moderate profile implant will have a base diameter that is too large (larger than your breast base width) to fit properly in the pocket. More specifically, a moderate profile 350cc implant could be placed, but this will result in excessive shell folding – which I believe can increase shell fatigue and promote failure. For this reason the implant base diameter should closely resemble the breast base width.

Listed below are the base diameters for available 350cc (or the nearest equivalent volume) implants. I have used gel implants for this example but the saline implant dimensions will be similar.

                      Volume    Diameter    Projection
Mentor MP     350cc     14.2cm         3.1cm
Mentor MP+   350cc     12.5cm         3.9cm
Mentor HP     350cc      11.7cm        4.8cm

Natrelle 10    360cc      13.4cm        3.7cm
Natrelle 15    339cc      12.4cm        4.0cm
Natrelle 20    350cc      11.4cm       4.9cm

Because of their low surface area to volume ratio, HP implants are more round (more spherical) than are their low or moderate profile counterparts. In patents with thin tissue covering, this “round” shape may be more visible or evident in the final result. You could avoid this round shape by utilizing a moderate profile implant, but that will come at the cost of a reduction in implant volume.

Silicone gel-filled implants are softer and may be less imposing on breast shape. Therefore, the “roundness” of a HP silicone implant may not be as evident when compared to a HP saline implant, but that depends to some extent on the (over)fill volume of the saline implant

HP implants put more biomechanical stress on the lower pole and can cause delayed stretching of the lower pole over time.

I would use a subpectoral pocket for your implants in order to provide more tissue covering. In addition, silicone gel will offer a better cosmetic result because it will be associated with less wrinkling and rippling. Intraoperative sizing to maximize implant volume within your biodimensional parameters would also be helpful.

These are important issues which you should discuss with your surgeon so he/she understands your desires and goals. Best wishes.
 

Breast augmentation success, as with reconstruction, depends on more than the number of cc's or the profile requested. Have a detailed discussion with your surgeon regarding an assessment of volume in your present breasts, the volume needed, the design of the implant diameter relative to the breast base measurement, the range of stock implants available to choose from, and the choices in surgical approach and position of the implant pockets.  Then, try to get an idea of the surgeon's preferences by reviewing photos of past patients.  This will give you a basis to choose from the professional, technical, and artistic abilities you may like, or not, for yourself.

Given your narrow breast width I think that the HP implants would be best for you also.  Good Luck.  Dr Grant Stevens

I am not a fan of high profile saline implants for a number of reasons but I love high profile silicone implants. I use them almost exclusively and my patients love them as well Because silicone implants do not impose their shape on the breast the results can be very natural looking. High profile implants have more volume for a given diameter compared to moderate or moderate plus implants and since switching to them the number of patients wishing they had gone bigger has dropped dramatically. Good luck!

Thank you for the question and pictures.

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 I find the use of goal pictures to be very helpful.  in your case you could use your own before breast-feeding pictures as the goal. 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.

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.

Interestingly, the more breast surgery I do the more I see the correlation between profile and resulting breast size (if the base width of the implant is properly fitted to the width of the breast). 

I would recheck the width of your breast upright with the arms down but if it is truly 10 cm then you need a very narrow base-width implant of less than 10 cm and you have four choices of forward profile and saline-filled implants and three choices in forward profile in silicone gel-filled implants (assuming smooth, round implants from Mentor or Allergan). I find external sizers or sizing methods for volume to be of no benefit and are even misleading. A lowest profile implant will gain you about a cup size, the medium profile (not called that in gels) will gain you about a cup and a half, and the high profile saline (Allergan) or gel (Mentor or Allergan) will make you look about two cup sizes larger. The Moderate Plus saline (Mentor) is between the high profille two cups and the medium profile cup-and-a-half increase. The volume of the implant is based on its diameter and your choice of the profile. You're interested in the effect/look, not the number of cc's. 

 

High profile implants are usually successfull at giving a nice degree of projection and filling without being too wide.  Your base width is more narrow than wide, and I think you are considering the right direction for your augmentation.  Nothing is better than a professional exam by a Plastic Surgeon to answer your questions properly about size and shape as well as to implant location( above or below the muscle).  Good luck.

The pictures you show are a  breast shape that more closely resembles the moderate or moderate plus shape of implant. Unless you want a a result with significantly more projection (how far forward the breast pushes), don't use the high profile model. But spend some time with your surgeon who will help you have a better understanding of what it will take to meet your desires.

 

 

 

 

 

 

 

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, don't use the High Profile model.