Would it make a difference in medial cleavage to choose high profile implants vs. ultra high profile implants?

Question

Assuming this is a revision for larger implant exchange. Silicone, sub muscular placement.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to revisionary breast surgery.  I have to completely disagree with the opinions that I read below.  I think surgeons over think base width and chest width measurements. The higher the profile of implant and the steeper the angle of takeoff from the chest wall, the more defined the breast and better resulting cleavage. In my experience, ultra high profile implants result in the maximum cleavage.  Also, as implants get larger, there is improvement in cleavage.  The anatomy of the patient's breasts and chest wall as well as muscularity also play a role in the ultimate final outcome of cleavage.  Make sure that you see certified plastic surgeons to have extensive experience in revisionary breast surgery.  Best of luck to you.

Mark Chin, MD · Answer

Thank you for submitting your question. Cleavage, projection, upper pole fullness, and side breast are important in determining the shape of the breasts. Many measurements are taken on the breast including the base width of your breast and distance between the nipples.  Implants are generally centered under the nipple-areolar complex and wider implants create more cleavage and side breast.  I determine the maximum width of an implant that I can fit in the breast (usually under the pectoral muscle) by measuring the patient in the upright and laying position.  The nipples tend to spread apart with the patient laying on her back.  For a given volume, a narrower base implant (think 500 cc water bottle shape) will give you less cleavage and more projection while a flatter (500 cc pancake) will have less projection but more width.  Both may have the same volume yet very different shapes. For a given volume, high profile implants will be wider than ultra high profile implants but a patient can still get the same cleavage with an UHP by going larger, if the tissues permit.  Implant charts have the width and projection of all implants.  Nipples too close together limit the size of the implant and placing too wide of an implant or too big may lift the muscle attachment off the breast bone and result in what is called a "uni-boob" or symmastia/synmastia where the implants are too close together and lifts the skin; this is a difficult condition to repair.

Gerald Minniti, MD, FACS · Answer

Hello,The size and position of the implant pockets are more important than implant profile in determining the appearance of the cleavage. Go visit a few ABPS certified/ASAPS member surgeons who specialize in revision breast surgery. Best of luck!

Anita Patel, MD, FACS · Answer

Yes, the profile of implant makes a difference in the appearance of the cleavage. Which one would be better for you requires more information to answer. I think some patients assume the higher the profile the better, but this is not true. The implant profile is just one of many factors your surgeon must consider when choosing the best implant to meet your goals. You are better off showing the surgeon photos of what you would like to achieve, and then letting the surgeon use her/his surgical judgement to determine which profile implants will get you to your goal. The higher the profile, the narrower the implant, for any given volume. In many patients the moderate plus profile implant gives the best cleavage, while the higher profile implants give the most projection. Other factors to consider are your current breast shape and volume distribution, current cleavage or lack thereof, width of the space between breasts, diameter of each breast, overall frame configuration (does your breastbone stick out farther than the rest of your chest, or lay flat with, or cave in), current breast volume, whether or not you need a lift, how dramatic of projection you desire, what your goal size is, etc. Also, for revision cases, pocket modification may also be in order, and this too would affect the cleavage appearance.

Daniel Barrett, MD · Answer

Dear The better version of Me,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 synmastia repair (when I need to narrow the basewidth) but otherwise I try to avoid them.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Asaf Yalif, MD, FACS · Answer

By definition the ultra high profile will project more, creating more cleavage. I would consult with your plastic surgeon to discuss the pros and cons of the increased profile and some other options to enhance your medial cleavage. Best of luck.

Tim Sayed, MD, MBA, FACS · Answer

The best implant for you would be the implant, after measuring you and reviewing sizers and surgical simulation software models, that best fits your base width from each medial edge of your natural breast crease. One way I assess this is by pushing the native breast up and in to create the cleavage in the consult and see how close together the two pockets can naturally be made. If we violate this natural border by trying to bring them closer together than the chest wall dimensions allow, we run a real risk of symmastia ("uniboob"), which is hard to correct. Ultra-high implants have a narrower base width and more forward projection than high profile, which in turn have these same characteristics when compared to moderate plus and so on. For the same number of cc's, an ultra high profile implant will be narrower and might not span your whole natural breast width (depending on the size), and could result in wider cleavage than desired. This is where simulation software and exam are critical to properly counseling the individual patient.

Tom J. Pousti, MD · Answer

Yes, I think that it is important to select the appropriate breast implant type/size/profile when it comes to achieving specific aesthetic outcomes. In other words: everything, including profile of breast implant utilized, matters. You likely already know the keys to success:  careful selection of plastic surgeon and careful communication of goals. Best wishes.

Edward J. Domanskis, MD (in memoriam) · Answer

The cleavage is a function of three things, your anatomy, the implants and the surgeon's expertise in not making the pocket too large towards the size. Also, I may add , the size of the implants placed, the larger the implants the more projection and more cleavage. I listen to my patients desires and concerns and then explain the various alternatives and then we formulate a plan to achieve the result she wishes. Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery
 1441 Avocado Avenue, Suite 307
 Newport Beach, California 92660
 949.640-6324/1.888.234-5080(Ca)
 FAX- 949.640-7347
Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)
 Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors 
 Plastic Surgery- 2005-2017
 President,American Society of Bariatric Plastic Surgeons
Organoderm Skin care/ScaRxTape

Ronald V. DeMars, MD (Retired) · Answer

Yes, different profiles can have an effect on cleavage. Assuming the same volume, the higher the profile, the narrower the implant base, and the wider separated the cleavage.

Would it make a difference in medial cleavage to choose high profile implants vs. ultra high profile implants?

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