Medium Plus Profile or High Profile Implants for Breast Reconstruction?

Question

I am planning to go under an exchange surgery from expander to implants. I am 5'1", 105lbs., whose chest width (arm pit to arm pit) is 12 inches. In order for me to achieve a natural yet perky-looking medium B cup size, which between high profile silicon implants or moderate plus implants is recommended? If so, how many CCs?

Lewis Albert Andres, MD · Answer

AS you alluded to, there are different projection types for breast prosthetic implants.  There are low, moderate, moderate-plus, high, and extra-high.  In addition, to this, other factors to consider are saline vs. silicone, textured vs. smooth, as well as round vs. shaped.  All of these factors should be considered during your evaluation in order to assist you in determining which implant would be best for you for reconstruction of your breasts.  

	Breast width is, in my opinion, the most important determinant for breast implant size.  I also typically use a high, sometimes extra-high, projection implant as I believe that the projection is necessary post-mastectomy, since the breast tissue has been removed and the reconstruction is now completely dependent upon the implant itself.  This also gives a desired "perky" and "lifted" breast mound appearance.  

	Giving you recommendations for volume is difficult without an examination.  However, as stated, measurement of your breast width (from sternum to lateral breast) is important to fit the breast pocket that will be created.  If you have had a tissue expander placed, exchange of an implant for a similar size volume during your second stage, once you and your surgeon have determined that you have been adequately expanded, may also give you an idea of which size/profile-type is best for you.  Hope that this helps!  I hope for an excellent result for you!

Larry S. Nichter, MD, MS, FACS · Answer

Higher profile breast implants are often needed post breast reconstruction to give a youthful perky appearance. Regarding choosing the best implant size for you: It is very difficult to determine 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 350 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. . 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 below link.

Ankit Desai, MD · Answer

Generally most patients who undergo implant based breast reconstruction where tissue expanders are placed and expanded until the appropriate size is reached benefit from high profile implants. Often I will also use extra high profile implants in patients wanting a perkier fuller look. To learn more visit our site below.

Antoine A. Hallak, MD, FACS · Answer

The right size and shape implant to be used after tissue expansion depends on many factors. Most important are the size of the pocket that has been expanded and also your personal preference regarding size and projection.
For a more perky and more projecting shape, a high profile implant will work better than a moderate or lower profile implant. Low/moderate profile implants are wider and flatter when compared to high profile implants with the same volume.
In a small frame patient like yourself I would anticipate using a high profile implant to achieve the perky (projecting) result you are looking for.

York Jay Yates, MD · Answer

The dimensions and volume of the expander should be your guide. If you and your surgeon are happy with the current width (base diameter) of the expander then that is the diameter of the final implant you should use. Similarly, the implant diameter can be chosen smaller or larger compared to the expander as necessary. The fill volume of the expander should be known which can help you decide which volume of permanent implant you would desire. One caution, for a low height implant, the permanent implant will need to be a little larger than the fill volume of the expander to achieve the same "apparent" size.

Raffy Karamanoukian, MD, FACS · Answer

In my practice, I limit my breast implant choices to medium plus and high profile implants in most cases.  This provides excellent projection of the breasts and limits lateral fullness of the chest wall.
In your particular case, both medium plus and high profile implants would be suitable.  The dimensions of the breast that you desire in terms of breast height vs. width dimensions is a matter of personal taste and must be addressed with your surgeon.  Your base diameter is an important determinant, as well as your breast proportions.  These should be measured and recorded by your surgeon.

Steven H. Williams, MD · Answer

Naomi - Thanks for the question.  It is a challenging one.
The reason it is so hard to answer is there are many unanswered questions -
These include:
What was the size and shape of the tissue expander?  How much was it over inflated?
What is the shape and position of your other breast?
Are you planning on surgery on the other breast?
What is your normal breast diameter?
It would be simply a wild guess to provide you numbers without an examination.
Sorry we can't provide more information.

Robert Whitfield, MD · Answer

Three basic forms of breast reconstruction exist.  You can use your own tissue, implants or a
combination of the previous two techniques. 
Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP
flap or fat grafting.  Implants can be
done in one stage or two stage.  Two
stage reconstructions are started by placing expanders at the time of
mastectomy.  Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.Implant choice for breast reconstruction in my practice done with shaped devices.  The projection is chosen based on the expander choice and the tissue response from expansion.

C. Bob Basu, MD, MPH, FACS · Answer

To achieve the "perky" look after post mastectomy reconstruction, I generally recommend either high profile (Allergan style 20) or ultra high profile (Allergan Style 45) silicone implants. The choice of the implant will depend on your surgeon's assessment of your base width and desired implant height. In addition, your surgeon will also likely reference the volume currently in your tissue expander implants.

Steven Schuster, MD, FACS · Answer

This is probably one of the most difficult parts of breast reconstruction. I use the dimension approach to determine base diameter and projection and then see what is available. I always make sure there are an assortment of sizes and projections for me to use as well as the sizers for trial during the surgery. This is usually left to your surgeon at the time of surgery after discussion as to size and shape with you. Your plastic surgeon may suggest doing something to the opposite breast to acheive the best symmetry such as a lift or augmentation.

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