Will the 1 cm difference in the base diameter in implants make me look wider on one side?

Question

My left breast is 75cc larger than my right. My BWD is 11. My PS has chosen mentor profile +. Should I consider a higher profile to reduce the width on the side that needs the larger implant? I'm considering 250cc and 325cc.

Craig S. Rock, MD, FACS · Answer

When using round implants with different base diameters, the concerns are both the widths of the final breasts as well as the heights of the final breasts.  The wider implant may result in a breast that no only appears wider but may also seem to start higher up on the chest wall, creating an asymmetry that may be very noticeable.Final breast size and shape are impacted by both implant characteristics (eg. size, shape, thickness of silicone gel fill) as well as the amount and distribution of breast tissue, skin characteristics and implant pocket location (eg. subglandular, subpectoral, "dual plane").  Depending upon implant pocket location and the amount and distribution of your natural breast tissue, implant diameter differences may or may not be noticeable.In general, I have found that moderate and moderate plus profile implants both tend to give a natural slope to the augmented breast, so they work well in combination to correct a volume asymmetry.  High profile implants (in women with smaller natural breasts) tend to give more of a push-up bra appearance post-operatively, which can be difficult to match to a moderate plus implant on the other side.Your concern is an important one, and I would recommend discussing it in detail with your surgeon.  Reviewing your options and addressing the potential trade-offs of each prior to your surgery will help to ensure that the procedure achieves your goals.Best wishes.

James H. Rogers, MD · Answer

It is difficult to comment on what would be the best implant combination for you without examing you or seeing your photos. In my opinion, using implants of significantly different base diameters will result in breasts that do not look symmetrical, particularly in the upper poles. If their is volume asymmetry in the breasts requiring different implant volumes, it is better to use implants with similar base diameters but different profiles...using a lower profile, smaller volume implant in the larger breasts. In my opinion, only the surgeon has the knowledge and experience to choose the correct implant for a given patient. In our practice, we have the patient demonstrate what they desire their breast to look like, and take the responsibility of implant selection. This relieves a great of preoperative anxiety for the patient.

Ashley B. Robey, MD · Answer

The more variables that can be identified as contributing to asymmetry, the better the possibility of your results. Some width variations are tolerated better on some patients than others. The larger breast may need a lower profile than the smaller breast and may tolerate a slightly smaller width. I would discuss this with your plastic surgeon. I will often have multiple options available to me at the time of surgery; I will then place temporary representative sizers to try on various combinations. I think it is worth the extra time and effort to get it as symmetric as possible the first time. That being said, true mirror-image symmetry is not possible. Best of luck!

Daniel Barrett, MD · Answer

Dear SHK2501,Implant profile is a very important consideration. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This has several problematic consequences. The first is that the patient loses width and therefor cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants. High profile implants do have a role in symmastia repair (when I need to narrow the basewidth) but otherwise I try to avoid them.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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Douglas Leppink, MD · Answer

Thank-you for your question! You have a good understanding of the issues that come into play with significant pre-existing breast asymmetry. Asymmetry is often addressed with different sized implants or implants with different projections (I have done this successfully on many occasions). But the critical thing to do during surgery is to sit the patient up and try different sizes and shapes to see exactly what is necessary to achieve symmetry. I know this requires implants "in and out," and raises the issue of increasing infection or capsular contracture risk. However, in my 25 years, I have not seen a difference in either infection or capsular contracture rate when this maneuver is performed. It is best to "try the implants on" to see what works best!

Tom J. Pousti, MD · Answer

Thank you for the question.  Remember that plastic surgery is as much an art as it is a science…  In other words, there are no hard and fast rules when it comes to diameter of breast implant versus diameter of breast (band width). In other words, these measurements are useful but are only one of the many factors come into play when it comes to selection of appropriate breast implant size/profile.My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.  Show your plastic surgeon what your goals using as many visual aids as possible.   As you can imagine, terms such as "natural" or "fake" can be interpreted differently by different people. This additional communication will go a  long way when it comes to helping alleviate your anxiety prior to proceeding.
 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. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.
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. I have found that the use of words such as “natural” or "C or D cup” etc may mean 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, best not to discuss your goals and/or judge the outcome of the procedure and Wisconsin, don't was insane so you can start some something one day before to work with the is a surgical note people is said performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.
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. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.
 One question that might be helpful for you to consider: would you be more disappointed if you are slightly too big or slightly too small after the breast augmentation procedure?
I hope this helps. Best wishes for an outcome that you will be very pleased with.

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