Which Breast Implants Result in Natural Slope and Cleavage?

Question

My wife is going to get Breast Augmentation in 3 months. She's 130 lbs, 5'4", 34A (breast fed 2 children), breast width was narrow, long torso and curvy hips, measured 1" on the upper pec/armpit area. We have decided on Silicone Breast Implants and under the muscle. She wants to be a small/medium C. One doctor said 350cc smooth high profile round implants. Our fear is we don't like the grapefruit look under the skin. We want a natural slope and decent cleavage. What are your thoughts? Which implant (high profile, mod+, mod) and what size would you recommend? Attached picture with measurements.

Otto Joseph Placik, MD · Answer

I offer patient's a simple analogy to illustrate what we mean:

	Q: If you take a baseball and you cover it with a silksheet, what will it look like?

	A: Like a baseball, you will even see the stitching.

	Q: Now if you take that same baseball and cover it with a comforter what will you see?

	A: It depends on how thick the comforter is but generally you will see a softly shaped lump.

	So now the question is what do you have on your chest, silk sheets or comforters?

	The way we determine this is by looking at your chest, if I can see your ribs (under the muscle) then you anatomy will have a hard time disguising the implant whether it is placed under or over the muscle and you are more likely better off with a silicone implant. Another way of measuring this is to pinch your upper chest skin (similar to pinch and inch of your waist on the Special K commercial). If you have less than an 2 cm (under 4/5 of an inch) than you have "silk sheets"

	If you have a thicker skin/fat/breast layer that pinches over an inch than you have the option of going under or over.

	Now the exception to the rule:

	Q: What happens if you change the baseball to a volleyball?

	A: All bets are off, whether you put it under or over the muscle it will not look natural.

	The last issue is the implant shape. A moderate or moderate plus implant that has minimal projection is more likely to be more natural appearing (less baseball like). However many paitents seek upper pole fullness and larger volumes with a small BWD and the only way to achieve this is with a high profile implant.  There are some anatomic shaped implants but I have generally found them to produce no significant difference in outcome with the exception of breast cancer reconstruction. However, this is my personal opinion

Johnny Franco, MD, FACS · Answer

The current trend in breast
augmentation is for a more natural result. 
There are several new additions to the breast implant family that makes
this much easier for your plastic surgeon to help you achieve this goal.

One the use of silicone implants has
made a dramatic change in terms of natural feel and shape.  The silicone implants over saline implants
are much softer and look much more natural. 
With a silicone implant a patient would have to place a much bigger
implant to have a very round “fake” appearance. 
This is because the saline implants are very firm and thus create this
round unnatural shape.  The silicone
implants because of how soft they are tend to give subtle and natural
appearance.

The other new addition is the use of
shaped implants.  Shaped implants are
great for patients that a very afraid of looking overly round and fake.  The shaped implants are made with a natural
slope to them, this way patients can have more natural shape with their
augmentation.  The shaped implants have
been great for my breast reconstruction patients and for patients that want a
larger implant, but still want to look natural. 
In smaller implants the difference between the silicone shaped and the
silicone round implants is very little.

Please discuss your breast augmentation
surgery with your board certified plastic surgeon and let them help guide you
during the process.

Larry S. Nichter, MD, MS, FACS · Answer

Simply put: Pick the best plastic surgeon that you trust, be clear about your desired outcome and let him/her select the best implant. It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below.

Gary Lawton, MD, FACS · Answer

Once you have selected a volume based on the visual you get from trying on sizers, the surgeon can use the measurements to determine which implant will give you the look that you desire.  If for instance you are using saline high profile round implants, you can achieve natural if you are at the low end of the volume range of a larger implant, if you choose a smaller implant and fill it to the middle of the range to get to the same volume you will get more cleavage and an intermediate look, if you choose the smallest implant that can be used to get to the same volume, and fill it all the way up, it will be the most projected of the three looks.  For silicone, you just need to look at the dimensions of the implants and decide with the surgeon which will give you the projection you are looking for.

Richard J. Bruneteau, MD · Answer

It’s important to understand
that breast implants come in all shapes and sizes. Choosing the right implant
depends on several variables including the patients underlying anatomy and
personal preferences.

Two of the more
popular implants are the round moderate plus and high profile varieties. These
breast implants have important differences and specific indications.

The majority of
patients require a round moderate plus implant. This implant gives a more
natural appearance. It has a broader base width and less anterior projection.
This results in a more natural slope and more cleavage.

In contrast, the
high profile breast implant has a narrow base with more anterior projection.
This implant is indicated when women desire more projection, and upper breast
fullness. It tends to give a more artificial appearance.

Although, it’s
impossible to know what implant is right for any individual without performing
a physical exam, the majority of patients require a moderate plus implant.

If you’re
considering breast augmentation, the style of implant chosen is one of the more
important considerations. Make sure, you discuss this issue with your plastic
surgeon so you can obtain the best possible result.

Richard Baxter, MD · Answer

There are several factors to consider. In general, silicone will feel and behave more like a natural breast. Then next step is to select the size, and the most common way to do this is trying on samples in a bra with the desired cup. Once the implant size is decided, then the implant with the best match of diameter to the base diameter of the breast is determined. That is how the cleavage will be optimized. In general, a high profile implant is to maximize volume on a narrow base, low profile to minimize size on a wide base. High profile implants have a steeper angle from the upper chest into the breast so they tend to have less of a slope.

David Shafer, MD, FACS · Answer

In my experience, under the muscle silicone breast implants give the most natural result. The extra tissue coverage from the muscle helps camouflage the implant look. Additionally, there is no question that the silicone implants feel much more natural than saline implants. Good luck with your surgery.

Kris M. Reddy, MD, FACS · Answer

Breast Implant Size is a combination of subjective and objective 
criteria.380 cc is a reasonable recommendation. There is not a direct 
correlation between the cc's of a breast implant and the corresponding 
cup size, as cup size is an inexact measurement that varies considerably
 among companies and even within the same company. Online consultants 
will not be able to guide you as well as surgeons who perform in person 
consultation.The size of the implants are based on a combination
 of a patient's goals and objectives and her anatomy. In order to 
provide a natural looking augmentation, the surgeon needs to evaluate 
many factors including soft tissue coverage, skin laxity, chest wall 
width, breast imprint width, the shape of the breasts and relative level
 of constriction to ensure that the breast implants are appropriate for 
your body.

Mel T. Ortega, MD · Answer

Based on your wife's photo, bra size, weight and height a 350-400cc moderate plus silicone implant would be my highest suggestion. Reason is, a high profile implant is selected more for petite women with a 30-32 bra size. High profile implants have a small base & project forward, giving the more "done" vs "real" look. Moderate profile implants have a wider base and much lees of a projection meant for a 34+ bra size. Moderate plus is basically in the middle, for a 32-34 bra size, projection is more realistic but still with some perk.

Tom J. Pousti, MD · Answer

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 or breast "look".  

	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 &ldquo;look&rdquo; 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 &ldquo;look&rdquo; 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&rsquo;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&rsquo; 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, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; 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. 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 &ldquo;I wish I was bigger&rdquo;.
	 I hope this helps.

Which Breast Implants Result in Natural Slope and Cleavage?

Answers (17)

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