Projection in Breast Implants
In my opinion these situations that we find ourselves in with patients can be simplified. Sizing is not about a number. In fact, I do not even discuss numbers with my patients. If a patient walks through the door and says they want x-cc implants I have to educate them about how sizing works. The best analogy I can relate this to is buying shoes. When you go to buy shoes how do you do that? First you start with the size your foot is right? So if your foot is a 6.5 you try on all kinds of 6.5 size shoes. Some may be tall, some might be flat, and some might be somewhere in between. You would never try to buy a size 8 shoe because it would be too big for your foot right? Breast sizing is the exact same way. Implants come in several different profiles that are like different heights of shoes. Implants can be low profile, moderate profile, or high profile. There are even implants that are higher than high. That would be your high platform shoe. Each implant style give you a different look. Now, your breast has a defined width that we call the base diameter of the breast. This would be analogous to the show size. Your breast base diameter never changes. It is what it is. So now, you can choose several different style of implants that fit the number of your breast base diameter. That really narrows down what implant is best for you. So once you know your breast base diameter you can try the low, moderate, high or really high implants on. The only think you have to decide is which look you are going for. You would never put an implant that is 13 centimeters wide in a patient whose base diameter is 10 centimeters. Half the implant would be in the armpit. So, this is very simple to me. My patients get a few choices that fit their breast and that is it. I will not put an implant in a patient that is too wide for their body because it will harm them over time. Hope this helps.
Projection in Breast Implants
In choosing implant size, the base width diameter is important. Patients do not want a large gap between the breasts and do want breast width proportional to their body size. In general it looks nice to have an implant width within a centimeter of your base width diameter (width of your natural breast footprint). Once you find the right diameter of implant, you can use different types of projection of implant (low, mid, high) to adjust the overall size of the breast and the appearance from the side view. Higher projection implants are generally a bra cup size larger for the same width of implant. Higher projection implants make your nipple look further out from your chest from the side view. In my office, I use a 3-D image machine to see approximately how the different implant styles look in each patient. Then you can try them on in a bra to see what bra size they fill. In your case, find an implant size that is wide enough and is a bra size with which you are comfortable. Also remember extremely large sizes sag more with time.
What is a Large Volume, but Low Projection Breast Implant Going to Do for Me?
Thanks for the question and posting the photos. I might suggest you attempt some weight loss prior to having any surgery. But if I had to chose I would opt for moderate profile plus implants in 450 to 550 cc range. Best to you.
Implant sizing in unusually wide breasts
Having measured breast dimension for years, I can tell you that the average breast width is 13 cm but this is for average chest circumferences around 34-36. I would imagine that you have difficulty fitting off-the-shelf bras and the same sort of problem arrises for fitting breast implants.
If your upright/arms down breast diameter is 17 cm then you need an implant that is about 16 cm in diameter to fit your breast and look natural. Usually a lowest profile (forward volume) implant that fits the width of your breast will make your breast look about one cup size larger. But in your case there will be more volume just to fill the width and it is hard to judge the size of your breast (as in bra fitting). The confusion in fitting implants is because two dimensions (for round implants) are determined by the width of your breast and the forward volume comes in different names and with imprecise effects. As was pointed out in one of the responses, the confusion you're seeing is because of not controlling for the width/diameter of the implant. Mentor's high profile saline-filled implant has this problem.
Start with the proper width of the implant for your breast and then choose a forward profile. In your case, I'd consider a middle profile as being in the middle of the range of forward projections. A low profile implant would be a rather wide and still get a somewhat flat breast and a high profile would be a huge volume and forward projection. It's possible your choices are limited when you get up to an implant with a 16 cm width. I don't have the charts available at the moment but 800 cc's is about as high as non-custom implants get.
Breast implant profile affects final appearance
You do have a broad chest which allows you wider based implant placement. Often selecting the right implant size and profile requires many different factors with BWD only been one of them. Typically a low profile implant gives you less outward protrusion and but adds fullness around the base of your breast mound. It also tend to give you a smoother transition of the upper chest. The volume that you choose will be based on how much bigger do you seek?
Stewart Wang, MD FACS
I consider two factors when selecting implants for my patients:
2.Gel Implant Sizing system
Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.
Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look. Hope this helps.
Combining Lift with Implant to maximize projection
In your photographs you appear to be leaning backwards. If you stood straight your breasts would actually be lower than they appear in the photographs. You would benefit from a breast lift at the time of implant. The breast lift can be done through a circumareola incision and lift your breast tissue higher, give you more upper pole fullness and increase your cleavage. An implant can be placed using this incision. I recommend silicone gel implants placed retro-pectoral since it is more stable long term and looks and feel more natural. The profile of the implant does not matter when placed under the muscle since the muscle compresses the implant. If you are large you can handle a larger size implant. However, if the implant is too large it will descend inferiorly and laterally and you will need revisions (450 cc implants weigh approximately 1 lb). Maximum projection is achieved by aligning your breast with the bony prominence of your chest. Combining a lift with implant will allow the use of a smaller implant. You are a perfect candidate for a technique called Breast Augmentation with Mini Ultimate Breast Lift.
Gary Horndeski, M.D.
Choosing the right implant
Choosing the right implant for you is best done in the office after a thorough exam. It is difficult to select an implant any other way. Good luck.
From your photographs you look like a patient with a wide chest with lack of upper pole volume. I would recommend moderate plus profile saline implants. They provide more projection and the saline implants can be placed through a smaller incision.
From your pictures it looks like you would benifit from a pretty big size. You did not mention what size you are going for. In our practice we tell our patients that 200-225cc is about one cup size. It has a lot to do with your body structure to see what size would look good on you or what it is you want to be. You need to go in for a Culsultation with a PS to get your adeqaute advice.