Hi, I am 5"2 - 95lbs. I've decided to get saline and my PS recommended moderate profile overfilled to get moderate plus effect to achieve a more natural looks and minimize rippling. 275cc overfilled to 300-325cc range realistically probably to 300-310 since I don't want the implant to be too big for my thin frame. I don't have broad chest so I'm a bit concerned w/ using a low profile implants since I don't want a unibreast. Do you think my PS recommendation is good? Thanks!
Moderate Profile Overfilled to Get Moderate Plus Effect?
Doctor Answers 9
"overfilling" saline implants
In my opinion, and that of probably most other plastic surgeons, saline implants should be properly "overfilled" to minimize wrinkling of the implant shell, and it probably also somewhat lowers the risk of rupture over time. I one of my patients chose a 300cc saline implant, I would use a 275cc implant properly "overfilled" to 300cc. If too much overfilling is done, then the implant starts to feel firmer, and may show some 'scalloping" wrinkles around the periphery. I choose the profile (moderate, moderate plus, high profile) based on the implant diameter...for a given size chosen by the patient, which profile implant has the proper diameter in relation to the patient's chest and breast dimensions. By the way, without being able to measure you, your photos make it look like you have a narrow chest wall. You would want to make sure, with your surgeon, that the diameter of the moderate profile 275cc implant is appropriate for your breast and chest wall dimensions and not too wide (which would then dictate going to the moderate plus profile 275cc implant).
Bad choices in breast implants
I wasn't there when you met with your doctor but in my opinion, you are too thin with too little breast tissue to be an even half way decent saline implant candidate. Overfilled or not, moderate or moderate plus. What would serve you much better would be a gel implant under the muscle and if you are as narrow as you look, you might even find that a HP gel will work best based on your width (same look as mod plus saline). I see many patients like you and they are very happy with these choices.
Overfilling Implant Beyond Recommended Volume Voids Warranty
Saine implants should always be somewhat overfilled to lessen the chance of rippling, although I agree with Dr. Shafer that you will obtain your best and most natural result with submuscular silicone implants. I am unsure of the manufacturer of the implants which you chose, but I think overfilling a 275cc implant by 50cc may well exceed the recommendation and may void the warranty.
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Natural appearing breast implants
In my opinion, for the most natural result, I would suggest a silicone gel implant placed under the muscle.
Breast Implant Sizing
I am not in agreement with any of the decisions you and your doctor made. Because of your extremely small chest and breast size, you are not really an ideal candidate for saline filled implants. Silicone gel implants will give you the best results possible.
Beyond that, I would never overfill a saline implant in someone like you; it will make rippling worse. True overfilling is when more saline is added to the implant beyond the recommended range. In the case of a 275 cc moderate profile implant, anything above 300cc is overfill.
The choice of a 275 cc implant is too big for your anatomy and puts you at high risk for implant malposition (tissue stretch causing implant drop out or pocket closure causing high riding implant), inframammary fold disruption, and rippling. Symmastia, although also possible, is more likely a result of surgical error in pocket creation prior to placing implants.
Although a true physical exam would be most accurate, based upon your photographs you would be a candidate for an intermediate profile implant between 225 and 250 cc.
Best of luck!
Overfilled saline implants may not be best for you!
I absolutely agree that saline implants (when used) require the proper degree of "over" filling in order to minimize visible and palpable rippling, particularly when the patient is thin (with little fat layer to help cover and conceal the saline implant edges or ripples) and/or with little breast tissues of her own (same reason). You have both--the "double whammy" of potentially visible implants. But "extra" over-filling of saline implants is the wrong solution to your anatomic concern!
For this reason, I would suggest silicone gel implants, which will be more natural in appearance, cannot ever leak and deflate (requiring re-operation), are more soft and natural to touch, and will not have the rippling issues seen commonly in petite, thin, small-breasted patients like you who choose saline implants!
The latest generation of silicone gel implants is cohesive (more cross-linking between the silicone molecules), and they absolutely cannot leak or deflate. Even if cut in half with a garden shears, these soft solid implants become two solid pieces, like Jell-O cut into halves. The older generations of silicone implants could indeed leak, ooze, and rupture, and these are the ones where MRI scan can detect rupture or leak. MRI scans, in my opinion, are not only unnecessary for the present generation of silicone gel implants, but even by the FDA's own data, are INCORRECT 21% of the time, identifying "rupture" when only an intact and entirely NORMAL silicone gel implant is found at re-operation.
So, long story short, read my article (on the About tab of my profile page on this site) titled "Are Silicone Breast Implants Safe?" and do more research about silicone gel implants. I believe that while you may be happy with saline implants, you will be happier with silicone gel implants, and decrease the cost and time off work for a second surgery to replace your saline implants with the ones you should have used in the first place. No vested interest here, or hidden agenda--just the facts in thousands of patients over two decades of use. Honest!
Also, profile is based on the size implant you and your surgeon choose based on the desired size you wish. Then, the base width of the implant is chosen to best correspond to the width of your breast pocket. "Uni-boob" is caused by the pockets merging into one another, and that is caused by over-dissection by the surgeon trying to get the implants (too) close together in the midline to create cleavage. SO, the profile of the implant doesn't cause symmastia, the surgeon trying to use too wide an implant profile for your anatomy (or too big implants--same problem of excessive width, but different reason) and trying to make the pockets too large and close in the midline. That being said, your chest DOES look narrow, and high profile implants, or at least moderate plus implants, may indeed be best for you. More-than-appropriate overfilling of saline implants only causes excessive firmness, scalloping ripples around the edges, and higher likelihood of eventual deflation. Wrong solution--wrong implants!
You should also realize that the difference between 310cc and 325cc is one tablespoon of volume--this is an absolutely invisible degree of volume over an entire breast. You won't even be able to see a difference of 50cc, so if you're talking about "too big" for your small frame, you should be comparing 300cc vs 375cc implants. I fear your surgeon may be insufficiently experienced to give you this proper information, or you are trying to do more of the surgeon's decision-making than you really should.
Please consider another opinion or two (in person) with ABPS-certified plastic surgeons with enough experience to discuss the pros and cons in DETAIL. Then you have the best chance of getting the result you will be happy with long-term! Best wishes!
The "Right" Size is the "Best" Choice
Of course, there are matters about which experts disagree: the issue of over-filling a saline implant is one of those matters.
While proponents of over-filling often do so to minimize rippling, the "extra" volume added to the implant makes it rounder and less soft.
Given your narrow chest, you probably would benefit from a medium or high profile implant so that the width of the implant is slightly less wide than the width of your natural breast.
For a slender woman with sparse breast tissue to cover the implant, silicone gel-filled implants tend to show less rippling and provide a more natural feel.
Mod profile or not
I would have suggested silicone gel implants.
I agree with your surgeon about type size and shape. I would have suggested silicone gel implants to avoid rippling. You have minimal breast tissue and palpable implants will be an issue if you are concerned about how they will feel.