Implant height is very rarely discussed here. Would anatomically shaped "tall" implants be appropriate for me?

Question

I'm planning to have my first BA soon and I would like to have some idea of what implants might work well. Since I am fairly active I prefer the subfascial method using anatomically shaped silicone implants. I am 5'11", 157 lbs. My bra size is 36A. BW is 14cm. From suprasternal notch to nipples is 21.75cm and 27cm between nipples. My goal is NATURAL LOOKING, full breasts at most D. I'd like a smooth transition from chest to top of breast.

Michael Law, MD · Answer

You have clearly been doing a lot of research. I applaud you for spending time familiarizing yourself with the different implants and techniques. However, the MOST important thing is finding a plastic surgeon with the expertise to provide you with a result you want and someone who truly understands your goals. 
If you are active, find a plastic surgeon with expertise in providing breast augmentation surgery for athletes. If you are starting with an A cup and want a natural look, find a plastic surgeon with extensive expertise in providing very natural looking results in women with a small breast profile.
One can provide a "recipe" of a particular size, dimension and placement of a breast implant. But the end result will be very different depending upon who is performing the surgery. You should know about the type of implant and placement before surgery, and your surgeon should explain why he or she believes their technique will provide the most ideal result. 
I urge you to look at galleries of breast augmentation before and after images of athletes , in addition to a gallery that will include 100+ patient results to get an idea of the surgical skill of a plastic surgeon to perform breast augmentation for you.

Kenneth Hughes, MD · Answer

One of the most important aspects of selection of the implant will be the distribution of mass of your current breast tissue.  Most women have more mass at the inferior aspect and, as such, an anatomic implant will exaggerate this and create a more matronly look, which is fine as long as you are aware.  I would recommend submuscular placement over subfascial placement for a number of considerations articulated by other surgeons.   Also, realize that anatomic implants can produce a deformity with any rotation within the pocket.

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
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Paul E. Chasan, MD, FACS · Answer

Unfortunately, you have been reading too much on the internet. My specialty is revisionary breast surgery. I will make a few observations from being in this business for 22 years and over 3,000 breast surgeries. First, "subfascial" placement of an implant is basically a subglandular placement. The fascia is less than a mm in thickness and adds nothing to the strength and covering of the implant. It is a marketing ploy to make subglandular placement seem better than it is. My experience with subglandular placement of implants is that most of the issues occur many years after the placement of the implant. The most common problems are a much higher rate of capsular contracture, wrinkling (even with silicone implants), and a slide down of the implant down the chest wall with time. I have gone away from any subglandular/subfascial placement because I see these issues way too much. I see a lot of figure/fitness competitors, triathletes, and other active women in my practice being in the San Diego area. There are ways to place subpectoral implants and minimize the animation deformity issues. The advantages outweigh the disadvantage by a large margin.As far as "anatomic" or shaped implants, these have fallen out of favor for cosmetic breast surgery in the last few years. I have noticed clinically that I couldn't tell the difference in the look between a round and shaped implant. This observation was confirmed by a recent article in the plastic surgery journal in which experts were shown several post operative breast augmentation surgeries and even the experts couldn't tell round from shaped.Your biggest issue is the 27 cm inter nipple distance. That seems very wide. If that is the case, it definitely needs addressed with a circumareolar repositioning. I'm sorry about the long reply, but it's a rainy day in San Diego and not much to do. Best of luck to you.

Aldo Guerra, MD · Answer

Thanks for your question. When I discuss shape breast implants, I always give the patient the option to go with a tall or medium height breast implant. However, it doesn't always fit the patient's goals. When it does meet the goal to restore more upper pole volume (deflated breasts after baby) then these look really great. Whether you can have these in a subfascial depends on the thickness of the of the breast tissue. It should be at least 2 cm of pinch. Otherwise, you may need to go under the muscles. See my photo gallery below of shape breast implant results.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  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.   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

Nana N. Mizuguchi, MD, FACS · Answer

The choice of breast implants for breast augmentation surgery depends on many factors. First, you need to be evaluated to see if you are even a candidate for subfascial breast augmentation.  IF you are, your surgeon will help you select the appropriate breast implants to help you achieve your goals.Best Wishes,Nana Mizuguchi, MD

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Due to the customization of anatomic 410 implants from Allergan a pair of implants can be found to offer you a very natural overall breast augmentation result.  Based on your height alone you may be a candidate for the "full" height implant which can then be matched to a specific projection.  Talk to your surgeon, they will need additional breast measurements to ensure appropriate sizing.  Hope this helps.

Milind K. Ambe, MD · Answer

Thank you for your question.  It really is best to answer which implant style you need based on what look you wish to achieve. The measurements you provide are excellent but you would still be best satisfied by seeing some board certified plastic surgeons in your area and bringing them pictures of the look you want.  Let them help you decide what the best type of implant you need to achieve your desired outcome.  Best of luck to you!

Curtis Wong, MD · Answer

there are a variety of profiles that you should be able to choose from and your surgeon should be able to help you better visualize what you would get with 'taller' implants.  With your height, you will be able to accommodate larger implants so choose the volume that will give you the look you desire then focus on what profile will work best for you with the emphasis on the width being way more important the the height.

Implant height is very rarely discussed here. Would anatomically shaped "tall" implants be appropriate for me?

Answers (17)

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