Why do some moderate profile implants appear really boxy, wide, & matronly but others not?

The augmented breast is the sum of the size and shape of the implant plus the size and shape of the existing breast.  If a woman has an attractive breast shape, then any implant that does not overcome that shape will look fine.
The breast you describe with the low nipple is likely a constricted breast which typically has less volume.  So the implant has more influence on the final shape.This is why a lot of importance is placed on the desired implant diameter, which is not the same as breast diameter.  I always recommend implant size by measuring the distance I want to see between the breasts and then mark laterally so the implants are well out  of the armpit.  So if that measurement falls between 12.0 -12.5, I select an implant of the expected profile. If the patient wants to go up in volume, I do not select a wider implant of the same profile.  I look at the next higher profile that is 12.0-012.5 cm diameter.
I think that implants that fill out the armpit make patients look heavier so I try to avoid that. 

One of the most common but erroneous concept is that a given breast implant size or shape has an affect on how that patient's breasts will look. Wrong. This is why I never mention what size implants I use in before and after photos, it only correlates to the patient, and no one else. Stop thinking that a given size or shaped implant will make your breasts look like someone else's. 

Thank you for sharing your excellent question.  Poor results often result from an improper matching of patient anatomy to the dimensions of an implant. I would be sure to seek out a series of consultations to ensure that you and your surgeon are on the same page regarding your expected outcome.  Hope this helps.

The short answer to your question is that moderate profile implants very often give inadequate projection for a given base width.  This often makes the breast look wider and less tear drop shaped.  That is why, in my practice, I very rarely use moderate profile implants.  High or full projection implants normally give the breast like appearance most patients desire.  Patients who request moderate implants are very often afraid of having phony looking breasts, but unfortunately moderate wide implants with minimal breast tissue often leads to a boxy appearance.All the above mumbo jumbo means that choosing the right Board Certified plastic surgeon who can evaluate all parameters is infinitely more important than choosing what style implant.  The right plastic surgeon with good before and after pictures, good reviews, and a great track record beats choosing the style of implant every time.

Achieving round, tight breasts that are not boxy depends upon unique tailoring and not cookie cutter patterns. In almost all women, round implants will produce a better result as the mass of most breast tissue is located in the inferior aspect of the breast.   Thus, round implants give more upper pole fullness, which is usually lacking due to involution or lack of development.  Teardrop or anatomic implants were developed for women after mastectomy to reapproximate the shape of breast if starting with nothing.  Thus, if used in most women, the result is a more matronly look with less upper pole fullness.Very few ultra high profile implants are used as they may have a higher probability of thinning tissue over time.  The difference in diameter and implant height among moderate, moderate plus, and high(or full) profile implants is very little and may be less than a centimeter in diameter for a given volume.  Your board certified PS will help you determine what profile may be best for your chest wall and breast imprint measurements once a volume is selected.

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Dear chi24,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD

Thank you for this interesting observation and question.There are two factors I believe that address your question.1) Width:  An implants width should fit the chest appropriatly. I like to see the diameter of the implant have enough width to balance with the shoulders and accentuate the curve of the hip. If an implant is too narrow the breast will look like a torpedo, if the implant is too wide the patient may look top heavy or " matronly". 2) Laxity of the starting breast:  If a patient has little natural tissue then their natural breast will take on the shape and curvature of the implant. If a patient has more natural volume and skin laxity Then the implant will fill out the top of the breast,  but the volume and laxity of the natural tissue will hang below the implant lending itself lower nipples and a boxier appearance as the extra tissue does not take on the shape of the implant. This is a patient where a lift or even lift with some reduction of the natural tissue may make sense to elevate the nipples and help make the breast take on the shape of the implant.Your ps will have to guide youe with realistic expectations dependant upon your own starting situation.Hpe this helps

Without seeing specific examples, it is not possible to comment on the results. However, Moderate profile implants are not commonly use. Moderate Plus are more common. See examples below. 

Hello chi24. To correct or avoid that boxy shape I recommend a HIgh Profile Silicone Cohesive Gel Implant with a narrow base and more projection, place under the pectoral muscle. You may see a video of some of my cases below.26 year experience
American Society of Plastic Surgeons
International Society of Aesthetic Plastic Surgery
International Society of Plastic Aesthetic and Reconstructive Surgery
Dominican Society of Plastic and Reconstructive Surgery
Board Certified