Mentor moderate plus extra vs moderate plus? (photo)

Question

I am 5'7, 125lb, 27 YO. Previous BA done 2022 from AA cup to A cup with 215 moderate smooth round implants. I realized I wanted to go bigger and have more projection and upper pole fullness. I'm concerned with my current implants "bottoming out" a bit. Would there be a preference between moderate plus and moderate plus extra for someone with little breast tissue like myself? I liked the idea of extra due to the upper pole fullness and less lower pole arc. I'm thinking around 375cc.

Donovan Rosas, MD · Answer

Profile differences will confer greater volume and projection as you move upwards in the offerings given a particular width. Going up in profile will allow a patient with a given breast width to achieve greater volume/projection without exceeding their measurements.

With regards to your specific question, as long as you are respecting the BWD there is no reason you could not move up in profile to achieve an upsize. It is important to remember the trade off for volume is a more "dramatic" less "natural" look.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. It appears that your nipple position is excellent in relation to your implant. It has been three years since your augmentation and you should be at a stable breast implant position at this time. I do not see your implants bottoming out. The increased size in your breast implants (215 cc to 375 cc) that you are considering could be done, but would require that you have a capsulotomy done to accommodate the wider implant and additional volume. It would likely give you more upper pole fullness, and narrower cleavage that you were seeking.  The dimensions of the moderate plus versus the moderate plus extra are very close and would likely not make an appreciable difference. If you feel that you would look best with the moderate plus extra then that would be the implant for you. If you were at all worried about increased implant descent over time because of the extra weight of the implant, you may consider having your plastic surgeon add a supporting mesh suture into your inframammary fold at the time of your implant exchange to add an extra layer of support. Speak to your plastic surgeon about your best options for this. Best wishes.

George Volpe, MD · Answer

there are lots of things to consider when undergoing implant exchanges. Be sure to discuss with your plastic surgeon all issues that you are concerned with so he or she can have a plan for them. Your current implants are quite small and moderate profile do not tend to achieve upper pole fullness. For sure the mentor series of extra profiles-moderate extra, moderate high extra, and high extra do all achieve more superior fullness. I find myself using moderate high extra mentor implants more and more when one is trying to achieve superior fullness. The high extras tend to be a bit narrow unless in much larger volumes. Of note in the photographs, the implants appear to be quite lateral with a large space in between. If this is your preference, fine. If you would want implants to be closer together, discuss this with your surgeon. Personally, I would place sub muscular implants and would perform medial capsule release (that means cutting the scar capsule around your current implants to allow the implants to move closer together) and also would perform what we call lateral capsular imbrication which means using long-lasting but dissolvable stitches to close down the outer pocket to prevent the implants from moving out to the sides in addition to an implant in the 300s. Hope this helps.

Mohamed Elmaraghy, MD, FRCS(C) · Answer

The difference in implant projection between these two types of implants will be minimal and likely in the realm of millimeters. This will not be clinically relevant. The selection of the larger implant will, by definition, increase the diameter and therefore the height of the implant. This will achieve more upper pole fullness. It is important to note that you are fairly long chested and have a low breast footprint. This cannot be changed with surgery. The larger implant by filling the upper pole will give the illusion of a shorter chest.

Daniel Barrett, MD · Answer

Dear Adventurous491662,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Morad Askari, MD, MBA · Answer

Thank you for your question. The Moderate Plus Extra implant may be the better option for your goals, as it provides more fullness at the upper pole, increased projection, and a reduced lower pole arc. However, there is still a risk of "buttoning out" due to your loose skin, especially since your current smaller implant (215cc) is already experiencing this issue. Increasing the implant size could further contribute to this problem. Your surgeon should examine you to determine if this issue can be addressed during the replacement procedure by correcting the pocket fold and using Galaflex for implant support, or if opting for a smaller size would be more appropriate.

Azita Madjidi, MD, MS, FACS · Answer

Upper pole fullness can be created with Moderate Plus  profile (regular or Extra) with a pushup bra. Without a bra, the upper pole fullness will be created with a High Profile implant ( regular or Extra or Boost). Your skin is already weak and bottoming out, so be careful adding more weight to the implants.

Gianfranco Frojo, MD · Answer

There is some slight implant inferior malposition ("bottoming out"). This could be corrected at the time of new implant insertion with correcting the pocket fold and placing Galaflex for implant support.

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question.
The difference between the moderate profile plus and moderate profile plus extra lies in the increased projection and volume for a given base width. It you want slightly fuller, more projected breasts than the extra is probably a better option for you. However, your concern about bottoming out is warranted. This unwanted side effect has more to do with the volume and weight of the implant than specific implant measurements. Increasing the volume by over 150ml will increase the risk of bottoming out overtime. You may want to ask your plastic surgeon about the use of absorbable mesh to provide additional support. Good luck. I hope this helps.

Ram Kalus, MD, FACS · Answer

Thank you for your question and photos. As you probably already know, a specific recommendation can only be offered after an in-person evaluation. Your photos demonstrate and pretty overall result which appears natural, but your anatomy demonstrates a fairly wide gap between your breast which can be nicely concealed with a wider implant.

There are many implant options, and the other important question is whether your implants should be subpectoral (under the muscle) or pre-pectoral (above the muscle or subfascial).

If not feasible to consult with your original plastic surgeon, please consult with an experienced board certified plastic surgeon whose results and reviews resonate with you and your own aesthetics. Best of luck to you.

Mentor moderate plus extra vs moderate plus? (photo)

Answers (14)

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