Should I Choose High Profile Implants or Moderate+?

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.  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 “look” 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 “look” 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’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’ 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 “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" 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 “I wish I was bigger”.

I hope this helps.

Hi Luna27!

Awesome question and thanks for the photo...I tell all my patients," See 10 plastic surgeons, and get 9.5 differing opinions and plans!". There is art and science in medicine in general, but a lot more emphasis on art when it comes to plastic surgery!

I have been using a higher number of Moderate Profile PLUS implants for my patients as of late because of the increased fullness in the upper pole of the breast. I feel the HIGH profile can at times give too much fullness and may give a more "artificial" post-operative look. However, I do take a number is measurements which individualize each patients needs and adjust my choice according to the patients goals and anatomy. I also have recently incorporated a 3D imaging computer into my practice which helps patients "see" what their potential result will be before surgery....patients love this new technology and helps me assist them in THEIR decision.

Looking at your photo, though, I would recommend a silicone implant because your new breast will be just about all implant...meaning that you will have little breast tissue coverage and therefore will have an implant that you will be able to feel...I personally think that my patients with your anatomy are much happier with gel implants in general. The exact profile will depend on your breast base width measurements and your post-op goals, but I am a fan of the MP+ for a more conservative profile and HP for less "natural" appearance.

This is my two cents worth and I hope it helps!

Regards-

Dr. C

johnconnorsmd.com

You have very thin breast tissue and moderate plus or high profile both will work. You may consider smaller implants than 325 ( I would suggest 275 c.c max)if you want as natural look as possible.

The other option is to have 3D imaging and try different size implants. I been using the 3D imaging for a while and I find it very helpful.

Using high profile vs. moderate plus implants may come down to personal choice.  For a woman with a chest circumference less than 30 inches a high profile implant is a definite choice if you want a more rounded result. Your breasts seem to have a wide base, that is the base of your breasts goes all the way out to the edge of your chest wall.  Every ones opinion is going to be different.  Make sure your plastic surgeon understands the shape and size you desire and together you can pick the implant size and shape designed to give your the best result.  This is definitely an operation that you want to get right the first time.   

I boils down to what you want.  Be VERY CLEAR on what you desire!!! Most women want good size (notable) breast when it is all said and done.  Based on what you want the plastic surgeon will advise you if that is possible.  In general HP implants give you more projections with a narrower width.  If your plastic surgeon uses sizers during surgery then he/she can place difference size and projection sizers in to determine the best permanent implant for you.

Dr. ES

Luna,

In my opinion with your tight skin envelope a high profile implant will look too tight and squeezed into your chest.  Go with the moderate plus.  325cc sounds like a good number for you to get to a full C.  I personally get a range of implants available for the surgery.  Then during the surgery I sit the patient up on the table (while under anesthesia) with a breast sizer in place to determine the best volume.  The sizer is filled to determine which volume best fits your frame.  Two of the three docs that you've seen must have agreed on one or the other.  Go with majority rules.  Good luck!

For most breast augmentation patients, finding a doctor who you trust and selecting the right size implants are the most critical decisions.  For your frame, you need to realize that the appearance of your breasts will be mostly determined by the implants since you have very little breast tissue to cover them.  Therefore, I think for a more natural look, you should be considering silicone implants.  Next, for my patients who say "I want nice, sporty looking boobs, not too big but definitely not too wide or flat. Also I don`t wanna look like I`m all boobs. I`d like to achieve some nice projection, while maintaining a quite natural and perky look." I would lean towards a smaller implant projection to help achieve these goals.  Therefore, I would probably direct you towards the moderate plus profile silicone implants that fit your breast width.  This probably would be right around 325 cc, so I think you are on the right track.

The implant profile is not as important as the volume. The high profile implant has gained popularity recently but it is secondary to choosing an appropriate volume for your chest size and skin dimensions. Typically high profile implants are chosen for patients who would like to have as much volume as possible but have a narrow chest diameter. Whether a Mod+ or High profile implant is good for you is something determined after a full consulation and taking measurements. Having a so-called "natural" look is very dependent on not having a too large of an implant - no matter what the profile is. Discuss this with your surgeon.

There is quite a push recently for higher profile breast implants, and they do fill a need for some patients who want a very full volume, especially when the chest is narrow. The high profile implant has a smaller diameter and will keep its more spherical shape even when you lay on your back. The breast will stand up on the chest. Also the edges are 'rounder' and the implant shape can show through the breast. If you want nice projection with a quite natural result I would stick with a moderate profile implant.

Best of luck,

peterejohnsonmd

Best for you to spend most of your effort picking your plastic surgeon rather than your 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.