Tighter or looser pocket? Which doc to choose for a more natural but full look?

#1 has 25+ yrs of experience and makes a larger pocket to allow some movement, which he says is more natural. I am concerned he won't achieve the fullness I want. #2 has 10 yrs experience and said the pocket is like "putting your hand into a glove" - the implant shouldn't move at all. I am concerned he will create a more fake look. #1 said 400cc mod+, #2 said 450cc UHP. I like the 450cc volume but am nervous about the UHP with a tight pocket. I want a full, but a natural upper pole. Advice?

Doctor Answers 12

Breasts implants size, type and pocket technique

Dear Kahivva,

   Front and side view pictures would have been very helpful. Also, it is critical to know your desired breasts cup size and the circumference measurements in inches of  your breasts and chest, for the correct selection of your implants' size.

   I have been in practice for over 29 years and performed breasts augmentation surgery on thousands of patients. I use almost exclusively, smooth, round , moderate profile saline implants made by Mentor. (The reasons are too many to spell in this session, however, if you contact me, I will be glad to provide them to you)

      I create large pockets and instruct my patients to perform X 3 daily, implants displacement massage, in order to reduce the likelihood of capsule contracture  and allow the implants to settle faster and more naturally with nice cleavage and nice upper pole slope.

    You have to realize that not all result are the same, because experience, skills and aesthetic eye are critical for good outcome. So , do your due diligence carefully and choose your surgeon wisely, to avoid bad result and need for corrective surgery.

   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.

                         Best of luck,

                                            Dr Widder

McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews

Breast augmentation

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  The size, profile, and shape of the implant and the size of pocket dissection is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  This entire surgery can be performed with a small incision technique.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by the two surgeons you are choosing between and evaluate their results.  

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 126 reviews

Breast Implant Pocket


It sounds like you are doing your homework which is important. From what you are saying, I think you are probably right between what the two opinions are. That is, the larger pocket is problematic because the implant can end up having too much room and could move too far to the side or even too low, etc. The tight pocket (hand-in-glove) is really only optimal for a shaped (teardrop style) implant. This way the implant will not rotate and look different. A standard round implant should have just enough room to move slightly so that you can massage the implant in each direction a small amount. The overall pocket size should be about 10-15% larger than the implant itself. 

I tend to use the newer Inspira implants from Allergan that give more fullness but aren't over the top in a full profile. I think the UHD implants are most assuredly going to impart a "fake" type look in the upper breast. 400-450cc will already give you plenty of projection in either a mod plus or full profile. 

Good luck with your upcoming surgery!


C. Coleman Brown, MD, FACS
Bethesda Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast augmentation

Hello and thank you for the question. The best answer to this question would require an in person exam and consultation. It's important to know that all plastic surgeons have different skills / opinions on how to best achieve the desired goal. 
I would suggest that the design of the pocket depends on what type of implant you pick. For textured implants, you want a snug well fitted pocket. For a smooth implant, a larger pocket typically works better. 

The difference between the types of implants will affect the look of the result. The size and shape need to be tailored to the frame of the patient. Generally the UHP will look more "pointy" or fake. You should include "goal pics" with your PS to make sure he/she knows what you want. 

It also depends on how much breast tissue you are starting with and your basic breast shape.  

As always, best to be healthy, no smoking, and make sure any health concerns you have are managed by your primary care md. 

Best to you

Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 21 reviews

Pocket and fullnesss

This opinion is offered without seeing and examining you and is just an opinion.

I am not a fan of a pocket that is larger than the implant because you tend to get too much movement of the implant when you lie on your back. You end up with a flat area in between your breasts and although that may be "natural" it certainly does not look good. In fact the more the breast and the implant move together the more natural the result.

When I first started using UHP implants I was a bit nervous but have been pleasantly surprised as to how good they look. The trend appears to be going with higher profile with thicker gel so you maintain the upper pole fullness.

It has also been my experience that very few patients complain about upper pole fullness; on the contrary, they tend to complain about the loss of that fullness as the implants settle in.

I would suggest that you do tghe following;

1. Show your Drs pictures of the way you want to look

2. See if you can try on implants using the Mentor Sizing system

3. See if you can get imaged using the Vectra imaging system

These will give you and your surgeon a good idea of exactly what you want and what they can deliver.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 34 reviews

Tighter or looser pocket.

Thank you for this interesting question.With a smooth implant under the muscle the forces of the muscle tend to push the implant outward over time. I tend to place implants as close to the midline as possible to enhance cleavage knowing that the pocket will enlarge by itself over time. I don't mind the pocket enlarging to some extent. It allows the implant to move around underneath and I believe looks more natural.

With a teardrop implant which is textured, you want a tight pocket so that the implant adheres and doesn't rotate. If these implants rotate they will look funny. These implants must "stick" inside. Because of this I feel they tend to look less natural.Sometimes the do rotate and can require revision.

So overall I tend to favor a smooth implant which can move around in the pocket. If a round implant rotates it will make no difference. A round silicone implant will take on a tear drop shape even if it is technically not a teardrop implant. I would favor not over enlarging the pocket because it tends to enlarge on its own.

I would really need to size you to give advice about volume, but UHP's in my opinion tend to look more fake.I have included a sizing link below.

Hope this makes sense and helps.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 104 reviews

Pocket size

Without examining you its really hard to give you specific advice about a relatively small difference in implant size.  Even after an exam, when I pick the final implant size I make the decision in the operating room after I place a sizer and see what you look like.  So my answer will be a bit generic.

Generally speaking, I think that an implant pocket should be SLIGHTLY larger than the implant.  A pocket that is tight around the implant makes your breast both firmer and more artificial.

I hope this helps.

Samuel Beran, MD
New York Plastic Surgeon
4.8 out of 5 stars 5 reviews

Breast augmentation

Like a chef, each surgeon is a bit different when preparing his chicken soup but it comes out chicken soup!

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Who to chose

As others have said, you have done your homework.  There is little difference in the volume of the implants but you are caught between to different styles in approaching the procedure.  No matter what the procedure the only advise I can give you is the same I give many of my patient.  Like a multiple choice test, your first answer is usually the right one and do not change your mind unless you are absolutely sure.  Second, if you are not sure at all, you may not be ready to move forward, so do not do it. 

Roberta Gartside, MD, FACS
Reston Plastic Surgeon
4.8 out of 5 stars 27 reviews

Choose the surgeon that you're most comfortable with

Thank you for your question. It is not possible to make a responsible recommendation without first performing a complete history and physical exam. If both of the plastic surgeons that you have seen are certified by the American Board of Plastic Surgery then they both are more than qualified and experienced enough to provide you with excellent care. You should discuss your specific concerns with them and choose the one with whom you feel most comfortable and confident. In general, the pocket should not be dissected any larger than is necessary to accommodate the implant. Also, a moderate plus profile implant will more likely give you a natural result than an ultra-high profile implant. 

Good luck!

Dr. Polo

Max Polo, MD
Miami Plastic Surgeon
4.9 out of 5 stars 40 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.