It is not unusual to get different recommendations from different surgeons. This can happen if you have expressed, or the surgeons have understood you to have different goals. It can also be the case that the surgeons have different preferences on how they do things, so what you are hearing is their difference in approach.
In your case it sounds like you are quite thin with little breast tissue. This means that your final result will be more of an expression of the shape of the implant rather than your existing tissues. If you prefer a more natural looking result then a shaped implant will tend to give you a more natural looking outcome without as much upper pole fullness while a round implant will result in more augmented type of look with a more rounded or full upper pole. So the choice of implant would be based on your personal preferences. The more tissue you have, the less apparent will be the differences in implants.
Some surgeons are not comfortable using shaped implants because they require a more precise and careful dissection of the implant pocket so that the implants fits very closely within the pocket that was created. This takes more time and attention to detail. All shaped implants have a textured surface so that once they a placed in the pocket there will be adherence between the implant and the surrounding tissues. This is important so that your shaped implant does not rotate which obviously would not look right. Because of this adherence your implant will not move around as easily on your chest wall. Some patients feel that this is less natural and they want their implants to have greater movement. In that case the patient would want to have a smooth surface implant, but again it is a matter of personal preference. Textured surface implants tend to have the look and feel of a more firm very youthful breast while smooth surface implants have more of a look of a mature breast.
It is complete hogwash to suggest that a particular type of incisional approach is more modern or advanced. Good results can be achieved with all three of the traditional incisions and each one has their relative risks and benefits. A more important factor is going to be the experience, skill, and judgement of your surgeon rather than any particular type of incision. You need to give a lot of thought to what sort of outcome you are looking for and then listen carefully as your surgeon discusses their approach of how they want to get you there.
Here is a third opinion:The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.
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.
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.
The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.
The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. 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 implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.
fulfills your goals. If your would like more of a natural shape then the shaped highly cohesive gel implants are the one for you. If you want more volume, rounder shape then the cohesive gel Inspira implants would be the ones you mentioned to choose. Now do you realize that both silicone generations are different? Did you know that the Mentor memory shape teardrop are gummy bears and the Inspira are not? The difference also relates to deflation and contracture incidences. Two things you will need to consider...If I were you...consider looking at Sientra implants too.
Thank you for your question. Different surgeons often have different aesthetics. I would recommend looking at their before and after pictures and deciding who's style you prefer. Generally speaking, Shaped Implants offer a more natural look as the implants themselves are breast shaped. If you wish to have more cleavage, round implants may be right for you. Additionally, each surgeon is basing this off of your anatomy, which is different for each person and difficult to tell without photos or an in person consultation. Make sure you're working with a board certified plastic surgeon. Breast of luck!
Yes, that is quite normal. If you include personal photos and goal photos, both sets in medical poses ie straight on and both sides with arms at sides you may get a concensus from consultants on this site.
And if you go to another surgeon, they may recommend something different. if you are unsure then go for another consultation. Best of luck.
It is quite common to get different opinions on implant type as different surgeons have different biases and preferences. The choice of implants really depends more on your anatomy and what you want your breast to look like. High profile implants give you a fuller look in the upper breast than tear drop shaped implants. Tear drop shaped implants also have a textured surface and tend to feel stiffer and have less movement than smooth implants. I prefer to discuss the different implant options with patients and explain to them how they will look with different profiles and sizes, then help them determine the best option for their body.I would recommend that you find a surgeon whose results as seen in before and after pictures most closely match what you are looking for, then consulting with that surgeon to discuss the options.
The most important decision that you will make is the skill and experience of your plastic surgeon. I would encourage you to evaluate the training, experience, board certification, and if possible real self reviews of the 2 surgeons. I would also encourage you to Trust your "gut feelings" about each surgeon and choose the surgeon that you feel most comfortable with. Once you have chosen a surgeon allow the surgeon to choose the implant style and shape and incision location that the surgeon is most comfortable with and feels will be the best option for you.
Different doctors will have different opinions about what THEY think might look best. Your surgeon should explain what looks the different implants will provide so that you and he/she can make the decision together. The tear drop shaped implant will provide less fullness in the upper pole and more in the lower pole of the breast beneath the nipple. The Inspira implant will provide a more round appearance to the breast with more fullness in the upper pole. Two very different looks. The question is...What are you looking for?
Hello and thank you for your question. The size, shape, profile, and texture of the implant is based on your desired
breast size/shape, your chest wall measurements, and soft tissue
quality. This decision should be based on a detailed discussion
with equal input from both you and your surgeon. This entire surgery can be performed with a
small incision technique. Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results. The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon