Ultra High or Moderate Profile? 430 vs 480cc saline? How big is appropriate for MY frame? 5'9, 131lbs, and active! (Photo)

Thank you for your question and your pictures. Let me just caution you and say that I see red flags all over this post. First of all, your surgery is in one week and you are still not decided on your size. Then, you are saying that your surgeon can not get you in for imaging until the day before surgery, which also seems odd.  And lastly, you tell me that your surgeon recommended ultra high profile, which I think is very rarely, if ever, indicated in a straight forward augmentation case such as yours. It could just be a difference in practice philosophy, but I would make extra sure you have chosen the right person to do your surgery and make sure you feel confident with your choices before proceeding. Your surgeon should be board certified by the American Board of Plastic Surgery and not another board. Please see the link provided for a list of providers in your area, if you do not find your surgeon there.........Good luck and be safe!

HP
implants, which are a more modern shape than moderate profile implants, fit
most women better. They have a more appropriate base diameter and can be
made to look very natural or very augmented, depending on where in the range
the implants are filled to achieve a particular volume. High profile
implants are the first choice in my opinion. I rarely find an indication
to use moderate or moderate plus implants. The subtlety in the final
outcome is not achieved by which profile implant is used, it is determined by
the skill in the creation of the pocket, the choice of volume, and where in the
range the implant is filled.The best way
to determine the size that fits your personal perception of the perfect breast
is to try on sizers. This way you can see how they fit on you, how they add to
your current volume, and whether they fit your frame. Although the surgeon can
guide you, only you will be able to tell what is the right size. Try on sizers.
HP implants, which are a more modern shape than moderate profile
implants, fit most women better. They have a more appropriate base diameter for
the average women's chest. Mentor HP profile saline implants have base
diameters that range from 8.8 cm (very narrow) to 13.8 cm (moderately wide).
The majority of women in my practice have base diameters in the 11 to 13
cm range. The HP implants fit them well. The moderate implants have
much wider base diameters for the same volume (often in the 14 to 15.6 cm
range). These implants are too wide for most women that I treat. So
when the base diameter is measured and correlated with the diameter of the
implant, it is most often necessary to use HP implants to achieve the volume
the patient is requesting. At the volume selected, my patient's base
diameters are too small for moderate profile implants. Measuring a diameter and
then telling the patient what volume they can have (in high, moderate or
moderate plus implants) in my mind is backwards. The patients should be
allowed to choose the volume. Then the surgeon carefully considers the
base diameter, projection, profile, manufacturer, and fill material that will
achieve the patients goals of size as well as qualitative look (natural,
intermediate, or bold upper pole fullness or projection), all the while taking
into consideration the patient's anatomic features that will affect the
outcome. HP implants can be made to look very natural or very augmented,
depending on where in the range the implants are filled to achieve a particular
volume. At the low end of the fill range, HP implants do not have the upper
pole fullness that most people associate with the fake look. On the other hand,
a fake over-augmented look can be created with a moderate profile implant if it
is overfilled (a common practice for surgeons that commonly use moderate
profile implants). In addition, too wide an implant will put the volume past
the anterior axillary fold, which in my opinion, looks more fake than upper
pole fullness. So there are many factors that need to be considered.
The experience of the surgeon and the degree to which they explain the
options to you is of utmost importance. Obviously all of my patients look
at photographs and we evaluate the look they are desiring in great detail.
For me, high profile implants are the first choice. I rarely find an
indication to use moderate or moderate plus implants. This does not make me a
better surgeon, or a worse surgeon. Look at the outcomes and judge for
yourself. The outcomes should stand on their own. The subtlety in
the final outcome is not achieved by which profile implant is used, it is
determined by the skill in the creation of the pocket, the choice of volume,
and where in the range the implant is filled. Don't let the doctor tell
you what would look good on you. They cannot tell what you perceive to be
the best size.

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements. Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid
silicone (less cross-linked), if this implant should rupture, it will leak only
into the scar capsule formed around the implant but may cause some discomfort
or implant distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.Best of luck!

Dr. Schwartz

Board
Certified Plastic Surgeon

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon