Will high profile implants look too round and full on my frame? 5’3” and 105 lbs. (Photo)

Question

I am getting breast augmentation in less than 2 weeks. I’m 5’3” 105 pounds, measurements are about 31-25-35. My PS and I have already decided on 295cc to take me from a small B to full C. She wants high profile for me but I worry that it will look too full at the top and too round. She says my natural breast tissue will help cover this and my chest isn’t wide enough for moderate profile. Will a moderate profile look too wide on me?

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your questionAfter performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Implants that are wider than this can be more palpable, fall more laterally overtime and also be more palpable. After that we will then choose the implant volume based on the measurements and also looking at any asymmetries you might have. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other peoples bodies and your results will probably be different.Silicone will give you a fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured. Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak. Implants, indifferent projections. The easiest way to think about it is they called me in a low medium and high projection or profile. Most of the time I use the medium profile which gives people the best in terms of natural look as well as a little bit of projection. High profile implants are for someone that wants  A little bit more of a fuller look. Low profile implants are better for someone that really wants a minimal extremely natural augmentation. Depending upon the anatomic versus round implants there are also subtle differences  in terms of the amount of projection for each profile. During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.In order to limit pain from breast augmentation and speed the recovery process I offer patients Botox into their muscles as well as a long acting numbing medication called exparel. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr SchwartzBoard Certified Plastic Surgeon #RealSelf100Surgeon#RealSelfCORESurgeon

Daniel Barrett, MD · Answer

Hi ceci_lia_1,
  
Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences. 
  
The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants. 
  
High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.
  
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements. 
  
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match. 
  
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
  
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well..based on the photo shown, I see that it is a good candidate for breast augmentation, in your case high-profile silicone material implants will be placed. To determine the amount of CC, my recommendation is that you be consulted in person to determine how much you need to get the desired result.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question. Judging
from your photographs alone, I think you can still achieve your desired full C cup with a moderate profile implant.  From a general standpoint, your question does
bring up the overall process of ideal breast implant selection which can
be quite involved, as breast augmentation involves a number of different
issues.  The first step would be to clearly define your desired
breast outcome goals – this would include the size you would like to achieve,
and your ideal breast shape.  I would then select the best breast implant
for you based on: 
(1)   Volume of the implant – actual
implant sizers that you try on during your consultation can help with
this.  I commonly used the Mentor volume sizing system for this purpose. In
general, 150-200cc is necessary for an increase in a single cup size.
(2)   Contents of the implant –
saline vs silicone, saline tends to be a little stiffer, rounder and can cause
rippling of the skin
(3)   Shape of the implant – round
or anatomic; I would show you how both round and anatomic can provide a natural
shape.  Different profiles of an implant would
also affect the projection of your breast.
(4)   Position of the implant – if
it is over or under the pectoralis muscle; each location would provide a
different shape and projection.  The advantage of going “under the muscle”
is that it provides a lower risk of capsular contracture, lower risk of skin
rippling, and better visualization on future mammograms.  Also, many
patients describe the appearance as more natural, and describe the feel as more
consistent with that natural breast. 
(5)   Skin stretch of your breast –
younger patients tend to have more taught skin with more… SHOW MORE resilience,
and respond well to an implant; compared to an older breast with more stretch
marks, which would typically requiring a larger volume to fill the breast 
(6)   Degree of breast ptosis
(sagging) – a significant sag would benefit from a breast lift
(7)   Breast diameter and overall
chest circumference
(8)   Native breast tissue volume –
the amount and distribution of the natural breast tissue. 
(9)   Any history of prior surgery
or trauma to the breast
The next step for you is to seek out a
board certified plastic surgeon who specializes in aesthetic plastic
surgery.  In your consultation, be sure your surgeon addresses all your
concerns and discusses the surgery details including the position and size of
the incision used (with actual photographs), the type of breast implants
available, the risks and benefits of the procedure, recovery time, and
post-operative course.  Also, be sure to see plenty of before-and-after
pictures in women who have a similar breast appearance to yours, and preferably
at different time frames (3 weeks out, 3 months out, etc) to more accurately
predict your own surgical outcome.
And lastly, I think the most important
component of the consultation is to establish a good connection with your
plastic surgeon.  It’s the connection that allows you to clearly define
your desired breast outcome goals, the first step of this whole process. If you
don’t feel you have a good connection with your plastic surgeon after your
consultation, he/she may not be the best surgeon for you.
For more information on breast augmentation,
please refer to the link below.
Good luck.
Mark K Markarian, MD, MSPH
Harvard-trained Board Certified Aesthetic
Plastic Surgeon

Donovan Rosas, MD · Answer

Profile terminology will vary from one manufacturer to the next. The terminology matters less than the correlate dimensional measures.
As one goes up in profile the footprint or BWD of the device will shrink and the projection will increase for a given volume. I have found that full profile Allergan implants correlate closely with high profile Mentor implants. These devices exhibit higher projection than similarly sized moderate (+)/moderate profile devices. Ultra high profile is simply the next step upwards in projection.
Patients are encouraged to stay within the boundaries defined by their BWD. This is the best way to avoid the dreaded "fake" look. I generally recommend that patients with smaller frames who are seeking more than a modest augmentation consider a higher profile device.The higher profile device will impart greater projection and thus a less subtle result but will allow for a more significant augmentation than a similarly sized Mod/Mod+. Thus, the ultimate question is one of volume. Is the volume you can achieve via a similarly sized Mod + profile implant adequate to reach your desired goals? If not, a HP will afford you more volume at the cost of subtlety.
The difference between higher and lower profiles for a given volume is projection and for a given width is volume (with the high profile implant being greater in both scenarios). The moderate plus is the most commonly used profile in my practice. It allows for the most reasonable volume in given BWD. In my practice, low profile implants are the least commonly used (widest and flattest). I will typically reserve high profile devices for smaller framed individuals or those seeking a less subtle more dramatic change (the opposite of natural). 
Smaller framed patients tend to prefer HP implants as their BWD can be restrictive with regards to volume. An HP implant will provide greater volume in the same BWD footprint. But remember "natural" while difficult to define often implies a good match between frame, volume and projection. If the goal is natural more conservative sizing/volumes are recommended.
In general, the difference between a moderate and Mod (+), in reality, is very small (on the order of millimeters). Anecdotally, most feel that moderate profile devices are too flat. In my practice, I generally classify profile based upon patient preference. A higher profile provides a more dramatic look (size for size) vs. a moderate/moderate + profile which is relatively more subtle and understated. That being said the vast majority of patients will select a moderate + profile device.Based upon your photos, unless you are willing to accept a more subtle upsize, a higher profile implant is recommended. A moderate (+) profile device will likely not deliver the volume you are seeking (but it remains an option).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  The size, profile, and shape 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. FACS
Harvard-trained plastic surgeon

Brooke R. Seckel, MD, FACS (retired) · Answer

High-profile breast implants look excellent when used appropriately.  You have good breast anatomy and should achieve a very nice result.  Bra size is difficult to predict.  I would expect that 295 cc breast implants will increase you by a little more than a cup size in the same style and manufacture of bra that you currently wear.  Your surgeons measurement of the base width of your breast will determine if moderate profile plus is possible.

Will high profile implants look too round and full on my frame? 5’3” and 105 lbs. (Photo)

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