Are High Profile Breast Implants Always a Bad Choice?

In Hawaii, I find most of my patients having a 34", 32", or even smaller infra breast chest measurement, therefore the narrower base on high profile implants tends to be a better choice.  Also, most of my patients have minimal breast tissue and very often thin skin.  The combination of the above tends to lead to traction rippling in the moderate plus implant augmentations. 

Moderate plus implants are 84% filled with silicone whereas high profile implants are 87% filled (Allergan silicone breast implants).  With a narrower base, high profile implants with greater fill have more tension at the implant surface which gives more projection and, in my opinion, less chance of traction rippling in thin skinned, low body fat individuals, especially such as yourself since you have moderate skin laxity. 

Taking all the above into consideration, if you were my patient in Hawaii, I would recommend you use high profile implants no matter what the volume of the implant you choose. 
 

I think that you are on the right path thought wise. A high profile implant in the right person may give an outstanding result. Your job now is to communicate with your plastic surgeon what you would like to look like. 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 “B+” 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.

I generally prefer high profile silicone breast implants and shy away form the use fo high profile saline implants which tend to look significantly more rounder.

If you have a narrow frame, and a chest measurement of 28" or less, the narrower high-profile implants can be a good choice. They often prevent too much of the breast from projecting laterally (out to the side.)

All silicone implants carry the same risks for rupture and capsular contracture. However, because you are looking for a narrower implant, high profile is the way to go. Check out some before and after pictures to see what size would fit you the best. As far as long term effects on the tissues, silicone implants are very well tolerated and cause miminal damage to the surrounding tissue. Being located in Baltimore, I could show you the actual implants so that you can get a true feeling for the difference between high profile and moderate plus profile implants.

Implants come in different profiles. For a given volume, the profile will become higher as the base diameter is narrowed. In general a moderate profile is a good combination for base diameter and volume without adding too projection to the implant. However, if you do want more volume that your own base diameter can handle, then you would need to increase the profile of the implant to accommodate the increased volume.

High profile implants, which have more projection, are more appropriate for women with narrower breasts or chest walls. To convert from a moderate plus to a high profile will not make a significant difference in projection or width, perhaps a few millimeters in each direction. However, if you want to be smaller in overall size or volume, then certainly converting to a smaller implant will achieve your goal.
While going smaller, you can then convert to high profile if you prefer; long term this will not have any significant detrimental effects on your breast tissue. Your skin and tissue have already been stretched with a 375cc implant, so downsizing to say 325cc should be well tolerated.
Please be evaluated by a board certified plastic surgeon prior to converting your implants in the future.

That is a great question.  First to let you know, my bias is that any surgery should look natural, including breast augmentation.  In Boston, my patients do not want to look "fake".  I would say that the implant that I use the most is a moderate profile plus round silicone implant.  I tell patients that we want to fill their tissues not overly stretch their tissues.  So if the breast is not "deflated" in appearance after children, then a moderate profile plus tends to look more natural.  High profiles and ultra high profiles can get a bad reputation for looking "fake" in the wrong patient. And if the breast is "tight" then the high profile may push too much on your tissues and cause some atrophy.   But if a woman has a deflated upper breast, then the higher profile can help to fill the upper breast in a natural appearing way.  Again, "fill but don't overly stretch".  The higher profile is narrower at the base for the same volume so it can also allow a little more volume in a woman with a narrower breast- but I don't like to overdo it.  So I think that high profile silicone can be a good choice for some patients. Much of this depends on your specific breast geometry and tissue characteristics.  So have a discussion with your board certified plastic surgeon.

Depending on your chest wall anatomy and goals, high profile silicone implants can provide an outstanding result in many women.  Please see a board certified PS to learn more about your options.

The more breast surgery I do the more I realize that there is no correlation between the size or model of implant 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 (saiine/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.