What profile looks best with wide set breasts? (Photo)

Question

I'm wondering which profile you think would be better for my wide set breasts? I want a natural result, full D cup. I'm worried that I'll have a large gap with my nipples sticking sideways. I have a choice of moderate 360cc or high profile 370cc, measurements attached. Diameters quite similar so I'm not sure if one would be better than the other. I'm having smooth under muscle, would over the muscle be better for wide set breasts?! For more cleavage

Aldo Guerra, MD · Answer

Hi Lauren.If you were my patient and I could measure your breast diameter, I would choose a breast implants that is about 3 to 5 millimeters wider than your natural breast width to get the best cleavage. I also would plane the surgery keeping in mind the pocket must be made very close to the center of the body, but without over dissecting the pectoral muscle. To answer your questions, wider breast implants will do a better job at getting cleavage to look good when wide apart. I also think the tear drop breast implants would be an advantage for you because they will look more natural and the firmer silicone will deliver better cleavage.Best wishes, Dr. ALDO :)

Robert Drielsma, MBBS, BSc, FRACS · Answer

Thanks for posting your questions and photograph.  You are in a good starting position and you should expect to achieve good results from breast augmentation surgery.  Its important to remember that your starting point in many ways determines your final result.  Implants need to be centred behind your nipples in order to look balanced.  If they are placed close together to create cleavage then your nipples will sit off to the side and look unnatural.  You need an in person consultation to determine which implant size and profile is best for you based on your individual measurements and a discussion about your lifestyle and goals.

Ralph R. Garramone, MD · Answer

Thank you for your question and for the photograph.  There are a number of issues that go into deciding the optimal size implant in volume and length and profile of implant.  I believe you will have a nice result with a moderate profile implant which will have a slightly larger diameter which would help to narrow the cleavage area.  There are some anatomical limitations to narrowing that area specifically where the muscle attaches to the breastbone.  I do recommend having the implants under the muscle for greater soft tissue coverage which is a definite benefit.  The position of the nipple is determined by the position of the breast and the chest and the configuration of the ribs and will not be affected by the implant.  If the nipples are wide set they will tend to be in the same relative position after the breast augmentation.  Best of luck.

Tom J. Pousti, MD · Answer

Thank you for the question. Based on your photograph, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. You are correct in that your anatomic starting point will to some degree determine how much space will be present between your breasts after breast augmentation surgery.  Other factors involved include careful breast implant pocket dissection and careful selection of breast implant size/profile.  Remember (when it comes to breast implant pocket dissection and achievement of ideal breast implant cleavage) that each nipple/areola complex must be centered on each breast mound. Ultimately, careful selection of plastic surgeon and careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging)  as well as careful measurements (dimensional planning) will be critical.
 
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 
On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position. 
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.
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. For example, 
I have found that the use of words such as “natural” or "full D cup” etc means 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, the use of computer imaging has been very helpful during the communication process, in our practice.
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, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes.

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