Is Natrelle SRX the best implant for me? Will they ripple up top because I am so thin and flat?

Question

I explanted last yr 275cc salines and am ready for new implants. I am 98lbs and wear a 34in band in a bra with very little breast tissue remaining. BWD is 11. I have had 2 consults, the 1st I just did not care for the office. The 2nd was a lovely Dr. He has suggested I go with sub-muscular Natrelle Responsive Extra Full 400cc (SRX) to achieve a D cup, but not too rounded up top. Do you agree? I worry about rippling with so soft of an implant and my little tissue. Thanks for your input.

Richard H. Tholen, MD, FACS · Answer

You are petite and slim, with very little subcutaneous fat and attractive but small breasts. This anatomy, IMHO, makes you NOT a candidate for saline implants (too much rippling, even with proper "overfill") or even the "standard" cohesive silicone implants offered by any of the 3 USA implant manufacturers.I presently use Allergan implants in most of my patients, but I have no objection with the quality of either of the other two companies' implants. Allergan presently offers 3 different cohesivities (firmness related to crosslinking) in their cohesive silicone implants--the "standard" Natrelle Inspira Responsive (cohesivity type 1) silicone gel implants with about 95% shell "fill," compared to the older Natrelle (non-Inspira) 85% fill, which had somewhat more ripple potential with thin patients like you. I would not recommend this for you--and the SRX (smooth responsive extra-full profile) is one of these potentially too-ripply implants that also has an unnatural very narrow base and very high projection, like a baseball filet steak.Their second level of cohesivity is called the Natrelle Inspira Soft Touch (cohesivity type 2) silicone gel implant, and the silicone (polydimethylsiloxane) molecules are a slightly more crosslinked silicone polymer--these implants are therefore slightly less soft and somewhat more resistant to rippling. This might be OK for you, but again, I would use the widest profile in your size choice to achieve the narrowest cleavage and the most upper pole fullness. (Since implants are round, narrow width--high, or extra full profile implants--also has the least vertical height, and therefore the LEAST upper pole fullness.) I use soft touch implants in a majority of my BA patients.Allergan's highest cohesivity implants (cohesivity type 3) use even more crosslinked, and slightly less soft, cohesive silicone gel, which coincidentally is the same cohesivity in the original teardrop-shaped, textured, style 410 implant that was first nicknamed the "gummy-bear" implant. It is called the Natrelle Cohesive implant (in a poor choice of terminology since all cohesivities are cohesive. But who wants to call them soft, medium, and firm?) Now all 3 implant manufacturers utilize cohesive silicone gels (each with somewhat different cohesivities) in their silicone implants, and the term "Gummy Bear" is now worthless as a differentiator, and has become a recognized marketing description, so I have abandoned use of the term "gummy bear." They're all gummy bears now! You should feel all 3 cohesivities in person and see how soft they all are (and how they differ in potential rippling), before you choose implant types. Once you choose a desired size, then your surgeon should choose the profile in that size (+ 10-15% to compensate for submuscular compression) that best fits the width of your breast base (not an arbitrary outside measurement, but the exact pocket dimension). This is the "correct" profile, not one chosen profile pre-op. I do understand that most surgeons do not have a complete on-hand stock of all sizes and profiles and cohesivities in both saline and silicone implants, and have to "decide" before surgery and order in a few likely choices for each patient. The fewer ordered, the fewer the options in the operating room, but then there are fewer restocking fees! I am lucky to have my own on-site office surgical facility that stocks virtually all sizes and profiles of both saline and silicone gel implants, with a full stock of both responsive and soft touch cohesivities. So I can decide the best option for each individual patient during surgery rather than ordering a couple pairs and see if they are what my patient needs in the operating room--I've got them here on-site already, or at least most of them. If you chose the type 3 cohesivity Allergan Natrelle Cohesive implants for the least likelihood of rippling, even I would have to decide with you ahead of time and order several pairs in what we think are the most likely ones we will need to achieve your goals. You should also probably know that Soft Touch are more costly than Responsive (several hundred dollars more per pair) implants, and the Cohesive (type 3 cohesivity) implants add nearly a thousand additional more per pair. Still, the increased ripple resistance is much less costly than a re-operation to place new more cohesive implants. Talk with your ABPS-certified plastic surgeon about these choices. SRX implants would not be my choice in this setting, with your anatomy. Best wishes! Dr. Tholen

Stanley Okoro, MD · Answer

Thanks for your question. My response is somewhat limited because I did not consult you myself. Rippling/animation is caused by many factors: pectoralis major muscle contraction, skin thickness, fat presence. If there is have enough fat and thick enough skin, many patients do not notice the rippling/animation in the implant. Discuss your concerns with your board certified plastic surgeon. Discuss the results of your “pinch test” and you two can make a great surgical plan. Good luck.

Tom J. Pousti, MD · Answer

Thank you for the good question.  
 
Personally, I think that careful selection of plastic surgeon and careful communication goals are  the two most important "factors" when it comes to achieving the desired outcome with breast augmentation surgery.  The specific breast implant manufacturer and even type of breast implant are far less important factors, in my opinion.
 Much of the final look and feel 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.   The more soft tissue a patient has present, the less important the type of breast implant is.
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. Careful measurements (dimensional planning) and careful selection of breast implant size/profile are part of the surgeon's  responsibilities.   Similar to point #1,  the more precise the breast implant pocket dissection, the less important the specific type of breast implant becomes.
Again, 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. In other words, if a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.   For patients with an extreme paucity of soft tissue coverage, the specific type of implant (for example, more gel fill per shell) may be more important when it comes to aesthetic concerns such as breast implant rippling/palpability.
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 or D cup” etc. may mean different things to different people
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
To summarize, my best advice: select your plastic surgeon very carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well.   I find that the use of goal photographs and computer imaging are very helpful during this communication phase. Working together you will come up with a good plan to achieve your goals. 
 Best wishes.

Brian K. Reedy, MD · Answer

Thanks for your question!  I think as long as you trust him and his opinion, you will be fine.  I do think the extra-full profile tends to be a bit more round and fake-looking than a full profile, but with someone so petite, he is probably picking the SRX because he wants to keep the implant from getting too wide.  I would tell you to trust your surgeon and make sure to look at before & afters. Best of luck!

Christopher T. Maloney Jr., MD · Answer

Thank you for your question. I am glad you had two consultations and found a surgeon and team you are comfortable with to perform your procedure. Since he was able to examine you and discuss your goals and options, he is better qualified than any of us on this website to help make a suggestion. This being said if you are worried about rippling, in my opinion I would use the cohesive gel implants (SCX) in this case. Going from a 275 to a 400 high profile is going to be large, but sitting here I cannot make that call. The high cohesive gels are best in my opinion to prevent rippling. Best of luck.

Is Natrelle SRX the best implant for me? Will they ripple up top because I am so thin and flat?

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Is Natrelle SRX the best implant for me? Will they ripple up top because I am so thin and flat?

Answers (8)

Answer: Natrelle SRX

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