460cc HP silicone unders to get desired look? 5'0, 110lbs, 33-24-37 (Photo)

Question

Next week I am scheduled for 460cc high profile silicone implants under the muscle. For the look I want, I was surprised he said high profile but he knows what I'd like to look like so I agreed. Thoughts?

Gary Lawton, MD, FACS · Answer

This is a good choice, as long as you tried on sizers.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.
 HP implants, which are a more modern shape than moderate profile
implants, fit most women better. They have a more appropriate base diameter for
the average women's chest.  Mentor HP profile saline implants have base
diameters that range from 8.8 cm (very narrow) to 13.8 cm (moderately wide).
 The majority of women in my practice have base diameters in the 11 to 13
cm range.  The HP implants fit them well.  The moderate implants have
much wider base diameters for the same volume (often in the 14 to 15.6 cm
range).  These implants are too wide for most women that I treat.  So
when the base diameter is measured and correlated with the diameter of the
implant, it is most often necessary to use HP implants to achieve the volume
the patient is requesting.  At the volume selected, my patient's base
diameters are too small for moderate profile implants. 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. HP implants 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. At the low end of the fill range, HP implants do not have the upper
pole fullness that most people associate with the fake look. On the other hand,
a fake over-augmented look can be created with a moderate profile implant if it
is overfilled (a common practice for surgeons that commonly use moderate
profile implants). In addition, too wide an implant will put the volume past
the anterior axillary fold, which in my opinion, looks more fake than upper
pole fullness.  So there are many factors that need to be considered.
 The experience of the surgeon and the degree to which they explain the
options to you is of utmost importance.  Obviously all of my patients look
at photographs and we evaluate the look they are desiring in great detail.
 For me, high profile implants are the first choice. I rarely find an
indication to use moderate or moderate plus implants. This does not make me a
better surgeon, or a worse surgeon.  Look at the outcomes and judge for
yourself.  The outcomes should stand on their own. 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. Don't let the doctor tell
you what would look good on you.  They cannot tell what you perceive to be
the best size.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

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. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

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 liquid
silicone (less cross-linked), if this implant should rupture, it will leak only
into the scar capsule formed around the implant but may cause some discomfort
or implant distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

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.

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.

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. Schwartz

Board
Certified Plastic Surgeon

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

Curtis Wong, MD · Answer

the profile is then selected.  Ask your surgeon how wide the high profile implant is and you can use a ruler and see how wide it will be on your chest.  You want an implant that will completely fill your breast width or even more if you're trying to narrow the space between your mounds.  Find out what width is of the moderate plus or next wider style with the same volume and see if it produces more of the look you want or not and then you will know if your style is suitable for your goals.

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 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.Given that your surgery is coming up soon, I would suggest that you spend additional time communicating your goals/concerns directly with your plastic surgeon, preferably prior to the date of surgery.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 "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.

Ronald V. DeMars, MD (Retired) · Answer

Thanks for the question and for including photos which are helpful. When you compare photos of you and the preop photos of your wish look, the other woman has quite a bit more natural projection than you and her post op result comes from a moderate plus profile implant. I suspect your doctor is leaning towards the high profile implant to compensate for your natural lack of projection. Unfortunately no one on this site can make specific recommendations in implant size for a patient without an exam and consultation as there are too many variables that have to be considered. But based on your stats it seems that something in the 400+ range might work. We personally do not pick a specific volume size before surgery, but rather use intraoperative sizing to get the patient's desired look and then choose from a multitude of available implants once we try sizers behind the muscle.

460cc HP silicone unders to get desired look? 5'0, 110lbs, 33-24-37 (Photo)

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