Moderate Plus or High Profile Gel Implants?

Question

I exchanged my saline 375cc MP implants for silicone 425 HP implants. I have formed a casular contracture and will be replacing again with silicone. I have loved the feel of gel but don't feel like the gels filled out my skin as well as saline. My question is: do I stay with HP and go up in size or try the MP? I have alot of my own breast tissue but feel like my HP 425 are not wide enough in diameter. My doctor is reluctant to make me too big. I measure about 15cm in breast width. Please advise!

Rian A. Maercks, MD · Answer

Your complaints are exactly why I use almost exclusively low profile implants in my 'cold-subfascial' technique.  I am able to cover the full width of the breast base and use the power of the fascia to create a beautiful tear drop shape.  I would recommend low profile implants with a well designed subfascial placement.  I hope this helps!

	 

	All the best,

	 

	Rian A. Maercks M.D.

Peter A. Aldea, MD · Answer

Respectfully, there are 2 issues involved here IN ADDITION to HP VS MP gel implants.

	Personally, assuming your torso will allow it, I would prefer the Gel HP implants over the MP implants because the HP gel implants are closest to the MP saline implants in dimension. Going to MP gel implants will give you a slightly greater breast width with a smaller projection.

	The other 2 issues that need to be discussed is that every re-operation scars the breast further potentially complicating subsequent procedures AND the issue of capsular contracture. In itself having had a contracture greatly increases the chances of another contracture. The new implant needs to be placed in a NEW pocket preferably under the muscle to reduce the chance of another contracture.

Barry L. Eppley, MD, DMD · Answer

If you feel that the replacement 425cc HP gels did not provide enough volume fill, then you need to consider more volume whether it is an MP or HP gel profile. Saline implants almost always provide more apparent volume than an indentical size gel because of the distention effect of water under pressure. (more upper pole fullness) Gel implants will have more comparative sag as the weight of the gel and how the bag is filled create more volume at the bottom  of the breast than at the top. You will need to get silicone volumes of at least 450 to get the look and feel that you want.

Bivik Shah, MD · Answer

If you think that the high profile implants are not wide enough, you should try the moderate profile or larger implants.  The profile is a reference to how wide the base of the implant (the width on your chest) is compared to how far it sticks out off your chest.  A moderate profile implant is wider for the same amount of cc's than a high profile implant.  Good luck!

Tom J. Pousti, MD · Answer

Thank you for the question.  I'm sorry to hear about the complications  you've experienced.

	If revisionary surgery is decided upon, it will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" means different things to different people and therefore prove unhelpful.
	Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. 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 press 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 have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.

	 I hope this helps.

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Moderate Plus or High Profile Gel Implants?

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