Breast Augmentation, Surgeon Picks Profile?

Had BA consultation. I am 5’4’, 110lb, 32 AA, 3 pregnancies. Probbly going for 325cc. We didn’t talk about profile at all, he said I don’t get to choose, it’s determined by my ‘chest parameters’ (not his words). He said he’ll pick it so it’s centered nicely behind my nipple. Is that normal?? Also, I’m anxious about scars, he said he does either inframammary or periareaolar, and it wouldn’t matter, it’s up to me, both are fine. Which incision would you recommend in my case? (very fair skinned.)

Doctor Answers 12

Implant profile is usually irrelevant

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I usually place implants retro-pectoral and the compression by the pectoral major muscle usually determines the final shape not the implant shape.  I see no difference between high profile and normal profile in retro-pectoral position.  In terms of the incisions, I use a periareola incision when the patient needs a lift done at the same time.  If a lift is not required then I would use inframammary incision.  Without photographs, I can't tell which one would be best for you.

Best of Luck,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Choosing breast implants and incisions

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In my opinion and experience with well over a thousand cases, patients appropriately get the choice of saline-filled or silicone gel-filled implants because I can get an equal looking result with either and the differences between them should be decided by how the patient feels about their advantages and disadvantages. The other choice the patient gets is the forward volume (profile) of the implant. The reason for this is that if the implant is sized properly for the width (which is also the height if round), the tissues of the breast will allow for the forward volume of the implant within those available (low, medium, high -- not always called that). The effect of this forward volume determines the gain in cup size from about 1 to 1 1/2 to 2 cup sizes (for breasts that are not unusually wide or narrow for their chest circumference). The number of cc's of the implants is determined by the width/diameter and the forward projection choice. When you think about it, you don't get to choose your shoe size or dress size, you get measured. The width of the breast upright with arms down determines the proper width of the implant and the patient should choose the forward projection/profile, not the surgeon or done with sizers in the operating room or using external sizers. You also don't want to start with the number of cc's and work backwards. 

I would condemn the use of the periareolar incision as it requires cutting through the breast and bacterial exposure in breast ducts may be a cause of capsular contracture. It is also not advisable to return to the implant through this route in the future if needed or desired. The best incision has turned out to be the inframammary crease incision and I no longer give patients a choice on this based on control over short term results, avoiding contact with breast ducts, and ease of return to the implant in the future if needed or desired. There is also better control of the inframammary crease level with an inframammary crease incision. For saline-filled breast implants this incision only has to be 2 cm and for gels about 3.5 cm or so. The scar is rarely a problem in that size and in that location. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast Implant Selection

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In my practice I have women select implant sizes and profiles with suggestions from me.  If they select implants which are far too large, I might refuse to perform the procedure.  As a general rule, persons who are fair-skinned will make scars which are better than those with darker complexions.  I also allow my patients to select between the 2 incisions that you were offered.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Your Most Important Choice is Your Surgeon. Tell them your desires & concerns. Let them discuss their recommendations for you.

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You should be most concerned with selecting an experienced board-certified plastic surgeon.  Interview the surgeon during your consultation, review plenty of their own photographs, ask to speak to some patients if that will help you decide.  The surgeon's service is more important than the implant in determining the quality of your results.

Tell the surgeon what you hope to achieve and list your concerns, so that they can take all this into consideration. 

Finally, expect them to discuss their recommendations for you, including how they hope to meet your expectations.

I agree that the surgeon will make the selection of implant based on your dimensions and tissue characteristics.  Both incision choices are frequent in my practice, but the inframammary is more common.

Hope this helps you. 

Sutton Graham II, MD
Greenville Plastic Surgeon

Implant profiles and incision choice

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The style or profile of the implant implant used should take into account your breast and chest dimensions and the desired volume of the implant that is going to be placed. If the implant is too wide for your breast base, it will have less coverage laterally and the implant may be more visible or palpable in this lateral area. I think the periareolar incision heals better and fades faster than the inframammary incision, but it can be difficult to place a silicone gel implant through the periareolar incision depending on how large your areola are. You should discuss this with you board certified plastic surgeon.

Todd C. Case, MD
Tucson Plastic Surgeon

Implants and durability

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While I wouldn't say that the choice of implant is solely up to your surgeon, I think that you should listen to why the surgeon chose those specific implants for you. As for the incision approach, it depends upon your anatomy and the type of implant you chose.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Who chooses the implant profile

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The implant size and profile is usually selected by the surgeon after careful assessment of your expectation and look that you have shown and discussed. When you choose your surgeon you will get his professional opinion and experience. You may be wondering if you should get a high profile implant, and if you can say no to the look. You should ask and express your concern as high profile is not for everybody. If the discussion does not go well you can look for a better listener.

Best of luck, Peter Johnson, MD

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Implant Profile for Breast Augmentation and Incision for Approach

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Thank you for your question.  Since scars fade in time, it is up to you to select which incision you would like for the surgery.

You can browse the internet to see different people's scars.  Google Images has about About 1,190,000 results in 0.35 seconds.

As far as the profile is concerned for a certain volume size, e.g. - 325cc for you, your surgeon just wants to make sure that you don't get an implant that is too wide or too narrow.  Each implant profile has a different width given the same amount of volume. In general, it looks best when the implant is centered under your nipple.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

How to pick breast implants.

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Hi.  I hope you find this article useful.  Let your surgeon select profile.  Which incision is best depends on your anatomy.

1)  This is the most common type of question on RealSelf.

2)  It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.

3)  Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.

4)  Then your surgeon has to tell you if your chosen look is realistic for your anatomy.  The most common mistake is to go too big.

5)  I recommend that  the surgeon NOT make a final implant choice in advance, because this is just an educated guess.

6)  The surgeon should have a large inventory of different size and shape implants available in the operating room.

7)  Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.

8)  Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating room inventory, and put in your breasts to complete the operation.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Communicate with your surgeon about implant size and type

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There is no perfect process for choosing implant size and type. It is important to have the implant centered behind the nipple or the result will appear unnatural. Also, if the diameter of the implant is not matched to the diameter of the breast, it will not look right; either too wide a gap in between or implants too wide squeezed in forming ripples. So the first step is to choose size (volume), and there are various ways to do this. Once that is known, then the right profile can be determined. That will be the one with the best diameter of the chosen volume. This can all be determined before surgery so you know exactly what you will be geting.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.