Can I get 415cc high profile with a lift?

I appreciate your question!

After performing hundreds of breast augmentations, I have found that 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. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you 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 softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is 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. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

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 

#RealSelf100Surgeon

#RealSelfCORESurgeon

It is very difficult to determine the best lift you will need (recommended based on your photos) or 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 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. 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 including silicone vs saline implant
#toobig #breastimplant

Thanks for the question. To give you an advice is good to have at least some photos or a personal evaluation. Its good to combine the patients wishes with what's good and safe for the patient. I recommend you a good conversation with your surgeon and to decide something that you are in comfort with . Kind regards  

Other than the profile, the difference between what you want and what the doctor recommends is only 10 cc's.  That is a drop in the bucket and I really don't think it would make that much of a difference in the final results.  Of course, he/she has examined you in person and I have not.  I use high profile implants frequently when I do breast lift surgeries with no problems.  It might be worth your while to get a second opinion from another board-certified plastic surgeon who can examine you in person before committing to your surgery.

Hi Whitney Lynn,Thanks for your question, it's a good one. I agree with your plastic surgeon. The presence of an implant pushing out your breast works against the mastopexy which pulls the breast in. So the bigger you go, the more the pressure which can translate into complications. From the standpoint of volume, the 415 high profile has 10 cc more volume than a 405 medium profile. That isn't much. From the standpoint of weight, it roughly translates to the weight of four pennies. The biggest difference is the width of the implant and it's projection. The 415 stands taller and it is narrower than the 405. Perhaps your surgeon is more concerned with the dimensions of the implant relative to your breast width than the volume. Talk to them, listen to their advice. I'm sure that there is room for compromise.Best of luck.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.   A breast lift with an implant can result in a very
nice shape if good technique is used.  Care must be taken to not select an implant which will be too large for your breast anatomy.   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.   
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for sharing your question.  Your surgeon was correct in that a breast lift performed simultaneously with a breast augmentation result in competing forces.  If too large of an implant is used relative to your skin laxity and skin excess you can risk wound healing complications, infections, and widened scars.  Unfortunately without a full series of photographs, or what your goals are, it is difficult to offer definite advice.  At worst the procedures can be done independent of one another for greater safety and predictability.

Many women that I see want what I call a " gravity defying breast". Your PS is correct. Lifts try to keep you up and tight, but larger implants want to go south over time. These operations especially as a one time combo tend to fight one another and have a higher need for touch up especially when patients go with a larger implant and start with a larger breast. The larger the amount of natural breast tissue the more it will go south over time. Natural tissue responds to gravity.I share this concept with my patients regarding a gravity defying breast:To achive a gravity defying breast you would consider a lift, with reduction of the natural tissue first. Removing natural tissue leaves less to droop.  Then come back and place an implant in the well healed tighter and smaller breast. This will be more predictible and gravity defying. By healing first the tissues and scars are less likely to stretch when the implant is placed.Now most people won't do a staged reduction, just to then do an implant. Most want one and done. But I hope this concept makes sense. If you go with a large implant and lift at the same time you are indeed to some extent fighting yourself.Hope this makes sens and best wishes.

Thanks so much for reaching out .  The difference in the two implants is very small. If you can fit 405 you likely will be able to fit the 415.  your surgeons advice is honest regarding larger implants in It fighting the lift. Be sure to see a board-certified plastic surgeon and a breast specialist to get the  correct plan.

There are  limits to good plastic surgery. Large size implants make lifts less successful. It is implant volume that counts and not the implant profile. Thus there are many factors that need to be considered while making right decision that will serve you best. My best advice to you can only be that you should not try to be your own plastic surgeon. Listen to your surgeon who has training and experience to guide you to a right choice.