Trans woman with 550cc moderate profile - Should I switch to high or ultra-high profile with capsule repair? (Photos)

Question

Hi! WI’m a transgender woman with 550cc moderate profile implants. I’ve noticed a little bit of bottoming out, and I’m planning a revision that may include capsule repair. I’m considering switching to high or ultra-high profile implants to help with projection and hopefully provide better long-term support. What would you recommend or are they fine?

Daniel Barrett, MD · Answer

Dear Heygirlxo,

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. 
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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

I usually steer towards lower profile implants and only opt for higher profile implants if the patient needs more volume with a limited breast diameter.
Anytime, excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will go up.
It does look like your implants are bottoming out, and this may in part be related to the size implants.
 Breast augmentation outcomes are based on three variables.
The first is the patient candidacy for the procedure.
The second is implant selection in regards to size shape and type.
The third is the surgeon’s ability to put the implant in the correct anatomic location.
Implants that bottom amount are usually related to surgeons opening or violating the IMF (infra mammary fold) this is often done to accommodate implants that have a larger diameter than the breast diameter.
Best,
Mats Hagstrom MD

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