Would a moderate profile or tear drop implant be better for me? Is a smooth implant safer than a textured? (photos)

Hi rachb93,

Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.

Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.

Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

hello thank you for your question and provided information as well.. based in your question and the picture you showed you are a good candidate for breast augmentation with implant with position subglandular with incision periareolar., in your case its recommended get a consultation in personal with a plastic surgeon to determinate how many cc do you need to get a very well result.

Given your desired photos, this should be able to be achieved with higher profile smooth round implants in the dual plane position. This way, there is less risk of malrotation of the implants and more recent studies show that there may be a small increased risk with textured implants.

For a vey round upper breast, I would suggest a high profile or ultra high profile implant that is smooth and round. Studies show that a teardrop, or shaped implant makes no difference in appearance once it is placed behind the breast. A shaped implant needs to be textured to avoid rotation in the pocket. Texturing has been associated with BIA-ALCL, a rare lymphoproliferative disorder, whereas smooth implants have not. Good luck!

Hi RachI would go with a round implant which will give you more upper pole fullness.  Smooth implants have a softer feel and no risk of ALCL but are more likely to wrinkle and bottom out over time.  For this reason I use mentor textured implants which have approx. 1:90 000 risk of ALCL.CheersDamien

At this time, most data suggest that BIA-ALCL occurs more frequently following implantation of breast implants with textured surfaces rather than those with smooth surfaces.  If the implants are placed under the muscle, a smooth implant can be used.  If an implant is placed in a subglandular plane, the implant should probably be textured.   The majority of implants placed in the US are round.  Most women are better suited for a round implant as the breasts usually lack superior pole fullness. Anatomic implants always have the potential for rotating and creating a contour issue.  You can achieve natural results with round implants, so I find very little use for the anatomic implants.  Lower profile implants can be ideal for patients hoping to increase fullness without creating a noticeably augmented look.  Higher projection helps to create a perkier, more lifted look.

It would seem that you are asking 2 different questions. Profile is different from shape. There multiple profiles of both round and shaped devices. The choice of shape is an entirely different question: round vs. tear drop/anatomicThe difference between higher and lower profiles for a given volume is projection and for a given width is volume (with the high profile implant being greater in both scenarios). The moderate plus is the most commonly used profile in my practice. It allows for the most reasonable volume in a given BWD. In my practice, low profile implants are the least commonly used (widest and flattest). I will typically reserve high profile devices for smaller framed individuals or those seeking a less subtle more dramatic change (the opposite of natural). 
In general, the difference between a high and Mod (+), in reality, is very small (on the order of millimeters).  In my practice, I generally classify profile based upon patient preference. A higher profile provides a more dramatic look (size for size) vs. a moderate (+) profile which is relatively more subtle and understated. That being said the vast majority of patients will select a moderate + profile device (especially those seeking a more natural and subtle result).
With regards to your specific question, you have a smaller frame and typically higher profiles are necessary to deliver greater volumes in more narrow or constricting dimensions.
I often find it is easier to decide on a profile, this combined with BWD will determine volume. Trying to match a particular volume to a profile may lead a BWD mismatch. In my practice, smaller framed individuals do prefer higher profile devices. I discourage pursuing significant volume as this is a hallmark of the "augmented" or "fake" look. Small girls typically have smaller breasts. Over-sizing leads to a frame mismatch which is not "natural."
With regards to your specific question, the risks of BIA-ALCL in the setting of textured devices have lead many away from these implant options in favor of more traditional smooth implants. It is important to remember that studies have shown that most cannot tell the difference between a round and a shaped device when placed submuscular.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Your breasts are a bit bottom heavy so an implant that maintains some upper pole fullness makes sense for you. Look into the Inspira SSF implant: all the advantages of a teardrop implant in a smooth round shell. Good luck!

Thanks for your question and photos. The recommendation is a sound one. However some practiomers aren avoiding textured implants unless an underlying condition necessitates this. There is a rare association with Atypical Large Cell Lymphoma with aggressive textured implants. Aesthetically, smooth round implants are going to be satisfactory in a partial submuscular pocket. Size is subjective but you should tolerate the size you have chosen. Hope this helps. 

Thank you for the question and pictures.  Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.  There seems to be is a moderate amount of breast asymmetry and the use of different sizes of breast implants may help to improve overall breast symmetry.   I also think that your goal photographs are realistic, understanding of course that goal photographs are communication tools not guarantees of exact outcome.These days there are a variety of breast implants available; the variety of breast implant available raise a lot of questions from women considering breast augmentation surgery. Personally, I think that for most patients considering breast augmentation surgery, careful selection of plastic surgeon and careful communication of goals, far outweigh the specific type of breast implant utilized (when it comes to the success of the breast augmentation procedure).
Anatomical breast implants were designed to better simulate the natural breast shape; the problem with these implants is that if they shift or rotate, the entire breast will change shape as well. This change in breast shape may require further surgery to correct. Round implants, under the hand, can shift or rotate without changing the shape of the breasts. Overall, I find that beautiful outcomes can be achieved with the use of round saline or silicone gel breast implants for the vast majority of patients.  I do not think that textured breast implants provide any whatsoever. 
 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation 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. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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” etc may mean different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.
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. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.
  
I hope this helps. Best wishes for an outcome that you will be very pleased with.