Moderate or high profile for athletic build? (Photos)

Question

I have already found a surgeon and have scheduled my BA for sometime in May. He reccomended inserting over the muscle because I bodybuild and have good breast tissue. I want a natural looking Full C cup.. my question is what would be best for my frame? I am 5'6 , 143lbs with obviously wider shoulders and chest. I'm really looking for an hourglass figure so my proportions currently are as follows: ~31 inches waist ~41 inches hip I'm also currently a 34B cup. Thank you for your help.

Kenneth Hughes, MD · Answer

With the pectus excavatum and medialization of the areolae, the width of the implant needs to be selected precisely.

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

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another. See the below link on some suggestions on finding the most qualified Plastic Surgeon for a BBL Always insist on a board certified plastic surgeon.

John L. Burns Jr., MD · Answer

I would suggest using 3D imaging to see the difference between the moderate and high profiles.  This will allow you to visualize the differences and choose the one that you like the best.

Tom J. Pousti, MD · Answer

Thank you for the question.  Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Ultimately, careful selection of plastic surgeon and  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, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.Make sure you carefully consider,  the short and long-term pros/cons associated with breast augmentation done in the sub muscular versus sub glandular position. You will find a lot of information regarding this topic on this website.You will find different surgeons will have different opinions regarding breast implant profiles;  there is no specific "right answer".  I prefer to have a wide selection of implants (all profiles) available in the operating room. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I find, that in my practice, the majority of patients undergoing breast augmentation end up with higher profile breast implants these days.
 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. For example, I have found that the use of words such as “natural” or "full C or D cup" 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 for an outcome that you will be very pleased with.

Marc J. Salzman, MD, FACS (retired) · Answer

One of the more frequent questions I'm asked as an aesthetic plastic surgeon for patients considering breast implants is "how do I know what size, and shape I need?” The answer to this question has changed dramatically throughout the 25 years that I've been doing breast augmentation. I've also learned that the words that patients used to describe either what they want or don't want can be completely misleading into what I interpret their meaning to be. Therefore, I like to request that our patients considering breast augmentation bring in photos of both what they think they like and what they don't like. There seems to be a multitude of sources on the Internet where these photos can be downloaded. By looking at the patient's desires, I get a better understanding of what they want. We no longer recommend that we place the exact implant on top of the existing breasts and then place a stretchy bra over it to give us any idea what that exact same implant under the muscle would produce in size. That method, in my opinion, will always over represent what the actual result will be. If you are going to use a sizing type method, then Mentor makes a shell sizing system such that, when the shell size corresponding to the implant that it represents is placed over the existing breast and in a bra, it will better represent what that size implant under the breast and muscle will look like. We've also used 3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this method, a three-dimensional photograph of the actual patient is taken and can be seen on a large screen television by both the physician and perspective breast augmentation patient at the same time. We then can place all of the different implants that are available under that image and decide what size, shape, fill ratio, and height to base width relationships will look best for each patient. Silicone gel breast implants come basically into shapes either round or shaped. They also come with either a textured or smooth surface. In my mind, there are advantages and disadvantages of every scenario and combination of those choices. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. It's then very simple to just look at size and ratio projection to base width and select the perfect implant for that patients shape and desire. Sometimes we would like to use a textured surface implant. Here the advantages are that the textured surface implants tend to migrate less in the pocket, as there is some frictional resistance to motion. Another advantage of textured implants is that the capsular contracture rate, especially when implants put above the muscle, is less than for smooth wall implants. Shaped implants, because we do not want them to turn in the pocket, are always textured. My planning method to optimize the best implant for each patient is begun with a measurement of the base width of the breast. We would then like to subtract about a centimeter and a half total off of that number so as to have coverage of breast tissue over the implant. We then will have a range of implants whose base width matches that number. If we go larger than that number, which sometimes patients will want, we as plastic surgeons know that these larger implants can have more problems down the line. For instance, larger implants may migrate below the crease which one has to lower at the time of surgery in order to get the implant in. When these implants migrate below the natural crease, they can create a second crease in what we call a "double bubble". Large implants can also; because of the pressure they put on the overlying breast tissue, thin that tissue out such that there is less overlying breast tissue over the implant as time passes. After we have the base width, our next decision needs to be what is the ratio of the base width to the projection of the implant. Essentially, there are usually four choices ranging from fairly flat which is called low-profile, to progressively more height and less width with the same volume of silicone gel, which is called ultrahigh profile. There are two profiles in between which are the ones more commonly used and these are called moderate profile and moderate profile plus. Common scenarios in which taller implants would be desired may be in patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that were trying to hold up. For patients who want a more natural look, a moderate profile or moderate profile plus shape is more desirable. There are also anatomically shaped implants. Rather than being around these implants can either be taller than they are wide or wider than they are tall. There are good reasons in patients to use either. For instance, in the patient's with very widely spaced breasts and a large breastbone, a shaped implant that's wider than it is tall can help hide that a little bit. Another example of the patient in who a shaped implant would be best, is that patient with laxity after childbirth or weight loss. When the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant that is anatomically shaped such that the nipple when is it at the lower two thirds of the breast mound created by the implant still looks good and natural and may obviate the need for a breast lift. By spending some time, long before the operation takes place, using the Vectra® 3-D imaging method, we can decide what type, shape, and ratio of width to height would best serve the patient's needs. We can then avoid what is sometimes done which is the placement of sizers at the time of surgery. These sizers, in my opinion, have a few negative implications. One is that there is a cost inherent in using them and usually multiple ones are needed to make a decision as to which implant would look best. I also believe that placing sizers in and out of the breast pocket can be traumatic to that pocket and can cause bleeding. For me, the state-of-the-art in today's breast augmentation is to decide long before the operation exactly which implant would look best using computer animation. A new wrinkle into the choice of breast implants is that breast implants now come with silicone gel that is filled to a higher volume in the shell where it is placed. This will allow for a round smooth implant, for instance to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant. Often times patients will present with breasts that are of different sizes. One of the options to correct this is to use breast implants of different sizes in order to best create symmetry. One of the newer methods to help in symmetry creation is to do what we call a hybrid breast augmentation. In the hybrid breast augmentation, the patient who has asymmetry of the breast to begin can have matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. In that way, no matter what the change in weight of the patient is over time, the breast is more likely to have the same or similar size. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins. As far as over or under goes, both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a narrower cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery. With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.

Moderate or high profile for athletic build? (Photos)

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