Should I go with high profile or moderate plus 450cc?

Question

So I went to two doctors for consults first one said I could go as big as 535 UHP silicone under muscle then I went to another doctor and he said moderate plus would look best and 450 is the biggest I should go. I am 5’4” and 119 lbs have had one child and am a 34a. Not sure if moderate plus is a good idea with a small frame? Confused.

Gerald Minniti, MD, FACS · Answer

Hello,Without knowing anything else about you or your consultations, I always believe the doc who recommends the smaller implant. Implant sizing should not be a qualitative decision, but one that is based in reproducible, objective measurements to determine you anatomic capacity (biodimensional assessment). Surgeons who rely on breast width (BWD) as their only measure are not doing this crucial assessment correctly.  That is why choosing an implant narrow enough to fit within the width of your breast - like an enormous, ball shaped UHP 535 cc device - does not mean you can actually accommodate it. In general, ultra high and high profile implants have higher complications rates than lower profile devices, more frequently leading to unpredictable tissue stretch, dropout, double bubble, capsular contracture (especially with nipple incisions), and rippling. Go visit a few ABPS certified/ASAPS member surgeons who understand biodimensional analysis and the 14 point plan to prevent bacterial contamination of breast implants. Best of luck!

James H. Rogers, MD · Answer

Without examining you, it is difficult to comment on which implant is best for you. Many variables go into making that decision, and most patients are not well equipped to do so. That is your surgeons job. Select a good surgeon, communicate to them what your desired results are, and trust them to make that selection.

Gary M. Horndeski, MD · Answer

At size 34 A, each
100 cc corresponds to 1 cup size change. 
450 cc implants weigh approximately 1 lb each, are too large to fit
under your muscle, will descend, cause complications and require revision.  If you have one child, you may have skin
stretching as well and you may need a lift. 
Another alternative for you to consider is a smaller implant with possible
fat transfers or possible lift.  Clinical
studies have shown that even plastic surgeons cannot tell the difference
between high profile and moderate profile after they have been implanted.  Best Wishes,Gary Horndeski, M.D.

Richard Hainer, MD · Answer

It is difficult to make any logical recommendations regarding implant sizing without photographs and a full physical exam including meticulous breast measurements. However based on your height and weight my feeling is that both implant recommendations seem somewhat large for your frame. Keep in mind that the higher the profile implant the narrower the implant and the more projection. Implant profiles are based primarily on base width of your breast as well as your aesthetic goals. I have found that preoperative sizing in the office is extremely helpful for patients in terms of choosing their appropriate volume. Once the volume is chosen then the appropriate profile can also be chosen depending on  aesthetic desires as well as exact breast measurements. Hope this helps. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as more importantly permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations. It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like. Best wishes!

Eric Swanson, MD · Answer

Both of those recommendations sound reasonable and you would likely be happy with those implants. My own recommendation would be to do something in between, for example high profile implants. Otherwise you may find your breasts stick out a little too much on the sides. This applies to silicone gel implants. I prefer moderate plus for saline implants. Having had a child means your breasts have been stretched. Usually a 450 cc volume is possible in this situation, but maybe more just depending on your tissue characteristics and that's a judgment call. Attached is a link to my website in case you wish to read more or look at some patient before and after photos.

Richard G. Reish, MD, FACS · Answer

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 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.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Daniel Barrett, MD · Answer

Dear tlb22,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.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I discuss goals with my patients and measure them, we then look at pictures of women with similar measurements with different size breast implants. My patients tell me that this process is very helpful in determining what is right for them.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Tom J. Pousti, MD · Answer

Thank you for the question.  
It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.  
Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible.
 
 
 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting 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. 
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or 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 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. The use of computer imaging may be very helpful during this communication phase.
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. The use of temporary intraoperative sizers and the tailor tacking technique with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
I hope this helps.

Should I go with high profile or moderate plus 450cc?

Answers (11)

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