Is "roundness" of the upper pole more a result of the volume of the implant or the projection?

Some doctors say high profile implants give more upper pole fullness and a more "fake" look. Doesn't volume factor in as much as profile when it comes to upper pole fullness? I am trying to decide between 385cc round Mod and 415cc round HP (textured Sientra implants). I want as much volume as my recommended implant diameter will allow to fill out my frame (5’ 10”, 130#, deflated A cup). I don't want severe grapefruit-like roundness in the upper pole, but some upper pole fullness is okay.

Doctor Answers 11

What Creates "Roundness" of the Upper Pole?

The appearance of "roundness" in the upper pole is influenced by many factors including implant volume and profile, whether the implant is placed under or on top of the muscle, how much breast tissue you have and how it is distributed, and the placement of the implant relative to your nipple position. 

Also the term high profile is somewhat misleading. When applied to saline implants, a "high profile" implant of most manufacturers was indeed too high and it looked unnatural on most patients. But a "high profile" gel implant for most manufacturers was more equivalent to a moderate profile saline implant and looks great on many women. So no, I would not say that a high profile implant has more of a "fake" look. In terms of the implants that you described (385 cc MP vs 415 cc HP), the larger high profile implant will potentially have more roundness of the upper pole, but the difference will be subtle. 

And then there is the issue of what is considered "fake". Remember, any augmented breast might be considered fake relative to a breast that isn't augmented. The excessively round grapefruit-like upper pole fullness that you describe tended to be associated with larger implants placed on top of muscle, particularly sailine implants. In general, gel implants have a softer more natural look, particularly when placed under the muscle. If you are concerned about having a "fake" appearance then you can consider getting a teardrop shaped or anatomic implant which has minimal upper pole roundness and a very gradual slope off the chest well, however some women do not feel that this implant looks augmented enough.

Implant choices are much more complex than you think

HP implants do not all look fake.  This is ridiculous.  Surgeons that simplify the complex discussion to this type of summary judgment are ignorant of the number of choices available from the three different manufacturers and have so little experience with HP implants that they have no business pushing you to make a choice based on this incredibly limited information.

Roundness of the upper pole is certainly contributed to by profile.  However, if you use a saline HP implant filled to the low end of the range, it will not give you the upper pole fullness.  If you want upper pole fullness, first you must use saline HP implants.  Second you need to be in the upper end of the fill volume range for whatever implant you choose. Third, the larger the implant, the larger the diameter, the higher the projection, and the larger the surface area.  All of these things contribute to upper pole fullness.  Lastly, you need to pick a surgeon who has experience in this area.

Now if you look at the silicone implants, even the ultra high profile devices, they don't have nearly the projection as the equivalent volume saline implants.  The Sientra HP implants have only 60% of the projection of equivalent HP saline implants.  Also, saline implants come in larger sizes.  You need to have a complex discussion with your surgeon about the available width, volume and projection of every implant that all of the manufacturers have to find the right one to achieve your goals.  You might end up choosing a Mentor, Allergan, or Sientra implant in silicone or saline.  

HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.

Upper Pole Fullness with Breast Implants

The factors which contribute to the outcome of Breast Augmentation are #size, #shape, and #profile. The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile.

#Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle. This tends to more common in Europe and South America. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option, #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding.

Each implant have their benefits. #SalineImplants is made with a #silicone outer shell that is filled with saline water during the surgery. It is filled with sterile saline (salt-water). Since saline is like normal body fluid, it is safe and easily absorbed if the implants were to leakThe #implant shell is ordered in a specified size which can be filled to a minimum or maximum fill amount. This allows the plastic surgeon some flexibility with sizing during surgery. Often times a woman has breasts which vary slightly in size. If one breast is slightly smaller than the other, each implant can be filled to a different amount to create better symmetry. Saline tends to be a little less natural feeling than silicone, but it can also create a more dramatic upper breast appearance, which some women prefer. A new saline breast implants option called Ideal Implant™ was recently FDA approved and was created for women who are not comfortable having silicone implants in their body, but desire a more natural feeling implant than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of saline.
#SiliconeImplants are made with a silicone outer shell and are filled with a gummy-bear consistency silicone on the inside. More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement.
To further ensure the safety, the FDA recommends women have periodic MRI testing to ensure their silicone implants are free from any defects. With both implant types there are choices

Your Plastic Surgeon will measure you to determine the best shape, size and placement of the #implants to be used. Lastly, another important element to a satisfying result of your #augmentation is realistic #expectations.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Many factors affect the shape of your breast

The contour of your breast is determined by many factors including your starting breast volume, the consistency of your breast and breast skin and the shape of your implant.  It sounds like you understand the importance of using an implant that fits your chest width and are trying to determine the difference in the effect that the moderate or high profile will have on your breast shape.  Although that true effect can only be determined by your physician during a consult visit, high profile implants do provide more of a round appearance to the upper breast.  Because it sounds like you have a minimal natural breast tissue the shape of the implant will essentially determine the shape of your breast after augmentation.  If you desire a round look, the high profile implant is likely more suited to your goals and will provide a more significant change in size.  If you want a more subtle look, the moderate implant may be right for you.

For many women it is helpful to see actual pictures of what your options for implants would look like in your body and some practices, like mine, have a 3-D imaging system called Vectra that allow you to do that.

Is "roundness" of the upper pole more a result of the volume of the implant or the projection?

the grapefruit look can happen in thin women with high profile implants, but in general the upper pole fullness is dependent on shape, and implant volume as well as implant based width. You need a larger wider based implant to give you upper pole fullness in most cases.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Roundness of the upper pole of the breast

I think the most important thing you have said in your question is that you want as much volume as your breast dimensions will allow. You are obviously a tall, thin woman, so you most likely can accommodate a larger volume than most women and still look proportional. Of course, I don't know your dimensions. If you are truly a "deflated A cup" the implant is the only thing that is going to give you any upper pole volume .So I doubt a high profile implant is going to look fake. This  new upper pole volume is due to a combination of volume and projection. Again, as long as you choose an implant that fits your breast dimensions, you should have an excellent cosmetic result. Good luck with your procedure!

Upper pole or "tropical pole"

Hi, thank you for the question... In my practice in venezuela I learn about how important the upper pole is.... To get this area full and round, there are several technics.. Depending of your need

Luis A. Mejia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 58 reviews

Roundness

Thank you for your question. Yes both volume and the profile of the implant will affect upper pole fullness. I believe the higher profile implants will give you a grater degree of upper pole fullness. The volume difference you mention is not significant. I would recommend a higher profile implant that still fits your chest dimensionally well. Best of luck.

Is "roundness" of the upper pole more a result of the volume of the implant or the projection?

High profile implants do give a more augmented look compared to other implant types. Volume also can play a role, but to be honest 30cc difference in size is not much. My experience is that all patients always wish they had gone bigger even though they were all nervous pre-op. Make sure you are open with your PS as far as your expectations/goals and that you pick an implant size that is a safe size for your body. When you pick an implant size that is too big this can lead to a higher risk of complications. 

Is "roundness" of the upper pole more a result of the volume of the implant or the projection?

Thank you for the question. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup” or "some upper pole fullness" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.