Implant Revision - Smaller CCs w/ High Profile Implant?

I am 5'5" and 100 pounds. I currently have 325 cc moderate profile saline implants but have rippling and bottoming out. I am having surgery again and my surgeon wants to use internal stitches and lift as well as go to a high profile gel implant. I would like to stay close to the same size. Do I need to go to a smaller cc if I am switching to a high profile implant?

Doctor Answers 13

Addressing Bottoming Out & Implant Rippling

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"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.

Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. . Rippling of #saline implant is unlikely a serious issue. If you are very thin or lean, any type of #implant can display some #wrinkling.  However, #positioning under the muscle may help.  Silicone implants do better than saline in this case. Also, adding a mesh (i.e. #ADM or similar) can help. Smaller implants, skin #tightening and #capsulectomy may also treat  #rippling or #wrinkling.  It is best to consult with your Plastic Surgeon to better confirm with an in-person exam. 

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

High profile implants

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The profile of the implant has no basis in regards to size, but has significant implications as to shape. You do not need to go smaller just because a high profile implant is being used, but larger implants will increase the risk of a recurrence of bottoming out.  I have developed a shape classification from natural 1/5 up to very round 5/5 which is being published next month. If you are going to have a smaller implant placed then it is important to make the pocket smaller by using internal sutures - capsulorrhaphy otherwise your implant will fall to the side. Certainly, switching from saline to silicone will help wrinkling. The higher the profile implant, the less the wrinkling, but the more round appearing breast will be. That is a decision that you must make between yourself and your plastic surgeon. I hope that helps.

Paul E. Chasan, MD
Del Mar Plastic Surgeon
4.9 out of 5 stars 46 reviews

Breast implant sizing

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It is very important to communicate your size goals with your surgeon.  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 cup” or "fake looking" 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 press 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.

I hope this helps.

It sounds like a good plan

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Rippling is more common with saline implants rather than silicone so this may resolve your problem.  You do not need more  or less cc's with a higher profile implant.  The difference between a high profile and moderate profile implant is the base width to projection ratio (moderate profile gets wider as the cc's go higher than the high profile implant).  Good luck!

Recurring themes with implants - use the solution to the treat the problem

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The problem is often not the device. Rupture, leakage are device failures that must be distinguished from bottoming out and rippling, which are placement and overlying soft tissue problems.

Implant revision

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The internal sutures will only help the bottoming out and will not help the ripplng. Depending upon where the rippling is, will determine what could help.  Sometimes strattice or alloderm can help with the rippling.  As for the implant selection, anh exam is critical.

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

Breast lift with sutures

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Breast lift with internal sutures is only effective for minimal breast sagging. A high profile implant will provide increased projection of your nipple areoala complex but provide a narrower base. So you really have to acknowledge what you are trying to achieve with your breasts in terms of breast mound size, shape, etc. A photograph would be very helpful.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 106 reviews

Implant Revision - Smaller CCs w/ High Profile Implant?

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You state that you want to be the same size, but that leaves alot for interpretation.  Go over exactly what your expectations and desires are with your surgeon.  Silicone gel behind the muscle with an implant that is within the diameter of your natural breast width will give you the least likely risks of rippling.  If your current implants have a large diameter that exceeds your breasts natural width, this increases the liklihood of rippling.  If you change to the same volume implant but a high profile, you will still be the same cup size, but the breast will not be as wide, this may decrease your cleavage and will lessen the amount of fullness lateral.  Be sure to discuss these things with your surgeon, and ask to see different profiles of implants that are the same volume (cc).  This may help you be sure what you want. Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Moderate vs high profile: deciding size

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The appearance between the moderate and high profile will be a little bit different with more projection and less width from the latter. This is also impacted by whether or not the implants are behind or in front of the muscle (which you did not specifically mention).

You need to more specifically inform your plastic surgeon on the specific look that you want. A 325cc moderate profile is the same size as a 325cc high profile. If you like the width but want more projection, then the high profile implant will need to be larger.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Implant profile determined by base diameter and desired size

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The most important factor in determining the proper implant is the anatomic diameter of the breast, which is called the base diameter. If the implant is too wide relative to the breast, it can get squeezed causing ripples. It sounds like your surgeon has determined that is what has happened in your case, so going to a smaller diameter implant but staying approximately the same size (volume) means  high profile.

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.