Confused after receiving multiple consults & recommendations, what size and profile would you recommend for me? (photos)
Doctor Answers 13
Confused breast augmentation patient
Earl Stephenson, JR, M.D., DDS, FACS
So many consultation, and so much confusion
This is not a snarky answer, and I think likely different from any you will get from others. I think you need a time out. None of us posting on this site can tell you any better than a doctor who has had a hands on physical exam. There is way more to this than measurements. Judgement, experience, tissue conditions, ribs, spine, muscle, patient expectations, and on and on.
You have had so many consultations that you basically know all there is to know, except how to make a decision. You know that there are many ways to do this procedure and everyone has a unique opinion. In the end, only your satisfaction counts. You must choose wisely, but how?
Take a time out. Promise not to think about this for a month. It will percolate in the background. Choose the top 3 surgeons and no more. Go in for another consultation with questions. Have the doctor put actual implants in a bra for you to try on and see how you like or don't like it.
If you don't get an "a ha" moment, take a time out, and it will come to you.
I know it is tough to decide, but you may be over-analyzing this to the point that you are confused. Time will help.
Confused About Breast Implant Selection
Implant selection can be a complicated process, and requires a complete patient examination and detailed consultation to reach that decision. Therefore, in many respects, the surgeons that have already examined you in detail are in a much better position to provide recommendations then anything someone else can tell you over the Internet.
In addition to base width, skin elasticity and breast skin envelope compliance are also important in the implant selection process. You do have a good starting shape, and so with a moderate augmentation, you should get a very nice result. I agree that a silicone gel implant would be your best option. With your continued desire to be very physically active, a subglandular implant position may be better, but this location does have a higher risk for capsular contracture. The Natrelle 410 would complement your preoperative shape very well. However, if you're going to continue to be extremely physically active, it would probably be best not to utilize this implant in a subpectoral position since there is likely increased stress placed on the shell as a result of the textured surface and its integration into the breast capsule.
I prefer subpectoral implant placement (greater tissue coverage, lower risk of capsular contracture, less rippling, improved mammography) and an inframammary approach (ability to make a longer incision, control of the inframammary fold, good exposure, reusable) because of the benefits they offer.
The simulation photograph you included certainly shows a nice result using a 375cc high-profile (style 20) round gel. You mentioned that you don't want your breasts to have a "softball look" or be "torpedo boobs". A high profile implant is more spherical in shape, and out of all the implants, is most likely to give this type of look. I believe high-profile implants also direct greater biomechanical stress on the breast anteriorly and inferiorly. In patients with less skin elasticity, this stress can lead to stretching of the inferior pole skin (over time), and additional implant descent, producing a high riding nipple-areolar complex. For these reasons, you may wish to consider a moderate profile (style 15) implant instead. This may mean that you have to settle on a slightly lower volume, but in the long run may achieve a better result.
There will be advantages and disadvantages to every decision regarding pocket location, fill material, implant style, and implant size. Ultimately you should settle with the surgeon that you believe understands your needs the best, and (the one you trust) will give you the results that you desire. I hope this was helpful. Best wishes.
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Confused about breast augmentation
Robin T.W. Yuan, M.D.
Not one way to do breast augmentation.
With regard to size, the first priority is to decide how big you want to be - remember this is for you. Use the computer imaging to help you make a decision on how you want to look. Then as long as the size is within a reasonable range for your frame, go with it.
I find that many people agonize over what is right and wrong, there is no right and wrong, there are simply pros and cons of each approach. Balance these pros and cons according to your needs and choose a size that makes you look the way you want to look within a reasonable range.
Implant sizing depends on several factors. One of the most important factors is your breast width. Generally, your surgeon will measure your breast width, and then provide you with a range of implant sizes appropriate for your native breast size. There are more nuances to it than just what I've described, but this approach works for most women.
I usually have my patients bring in a large bra and a tight t-shirt to do sizing. I'll then choose 3-4 implants that I feel are appropriate, and have my patients place them in the bra under the tight t-shirt. My patients can then look in the mirror and get a good sense of what they will look like with the provided implant sizes. My patients like this approach and get a great idea of how they will look.
By using this technique, your surgeon can outline a range of appropriate implant sizes that will be aesthetically pleasing, and you make the final decision.
I hope this helps. Good luck!
Breast enlargement choices
Confused about choosing breast implants–take a time out
I honestly believe your best course of action is to stop thinking about breast augmentation and wait 6 months before considering having breast implants.
That said smooth walled, moderate profile plus silicone gel breast implants are designed to mimic the natural shape of the breast gland and are the easiest implants for your surgeon to place through an inframammary crease incision. Most variations of this basic breast implant are designed for specific indications or to solve a problem. Your breasts are very normal and naturally shaped thus you do not need a special type of breast implant in my opinion.
Implant volume and cup size
Gary Horndeski, M.D.