What kind of implant would be best?

Question

I am just curious what kind of implant would be best?? . As you can see in the photo, although my breasts have some sagging, I still have quite a bit of breast tissue. My surgeon actually decided on 275-300cc moderate silicone implants in front of the muscle. I’m unsure of size. I want nice sized breasts but not enormous. I would also like the upper pole of the breast to be slightly filled as well. Would High profile be best, or should I stick with moderate??

Dallas Buchanan, MD · Answer

Thank you for your picture and questions. Dr. DeMars hit the nail right on the head. Silicone is usually preferred due to feel and less rippling. The more cohesive the gel, the more upper pole fullness will be retained. You would benefit from a lift. A high profile implant is projection, not height on the chest, a moderate profile implant will actually be "higher" on the chest for a given volume. Sounds like your surgeon is on the right track and if he or she is board certified by the American Board of Plastic Surgery, you are in good hands.Good luck!

Ted Eisenberg, DO, FACOS, FAACS · Answer

I can't tell for sure from the picture you posted, but it looks like you might need a breast lift as well. To help create more certainty for yourself, you might consider another consultation with a plastic surgeon to discuss your goals and be measured. My patients tell me that it is also helpful when we then look at pictures of women with similar measurements to see what can be achieved.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Jeffrey H. Lee, MD · Answer

Hi and thanks for your question!  A moderate implant is generally a good/safe choice when combining with a breast lift.  The complexity and risk when you do an augmentation with a breast lift is more than when you add the risk of the individual procedures alone.  That being said, it can be done in a perfectly safe manner.  A higher profile implant only adds to the risk profile of this procedure and I generally don't recommend going high profile.  Best of luck!

Tom J. Pousti, MD · Answer

Thank you for the question and the photographs.   Based on your photographs, I think that you will do well with breast augmentation/lifting surgery. Some general thoughts may be helpful to you:
  Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars and/or implant exposure. Make sure you also carefully consider,  the short and long-term pros/cons associated with breast augmentation done in the sub muscular versus sub glandular position. You will find a lot of information regarding this topic on this website.
Personally, I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 
On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle) that can be seen with breast implants placed in the sub muscular position.

Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work. 
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
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 or D cup" or "nice sized but not enormous" etc 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. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of the tailor tacking technique and the use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.

Ronald V. DeMars, MD (Retired) · Answer

Yes, you do need a lift. Most patients prefer silicone currently for the improved feel. Remember the term "High" profile does not mean high up on your chest. It refers to how far forward the implant pushes the breast tissue. If you look at a moderate profile and a high profile of the same volume, the moderate will go higher on your chest due to its larger diameter and give better upper pole fullness. Also the more cohesive the implant the more volume will stay in the upper pole when you are standing. For best long term results, under the muscle wins every time.

What kind of implant would be best?

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