Is an ultra high profile implant right for me?

Question

I'm 5'6", 125lbs with a breast width of 10.5 and I've discussed with my surgeon that I am ok with a slightly augmented look. I have a decent amount of breast tissue currently but very little upper pole and would like more projection. We discussed between 375-430cc uhp mentor implants. Would a high profile implant give me this same result? I'm having trouble finding a lot of information out there on uhp implants. Thank you in advance!!

Daniel Barrett, MD · Answer

Dear Lala121899,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

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question
After 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 Schwartz
Board Certified Plastic Surgeon 
#RealSelf100Surgeon
#RealSelfCORESurgeon

Urmen Desai, MD, MPH, FACS · Answer

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

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.  FACS
Harvard-trained plastic surgeon

Austin Hayes, MD · Answer

Thank you for your question. Without photos and an understanding of your goals, it's hard to make any specific recommendations. In general, a more augmented look comes from high and ultra-high profile implants. I would consider another visit to your surgeon's office to discuss your goals and try on implants again. Good luck with the process!

Curtis Wong, MD · Answer

on your own base diameter... but how much space do you have between the mounds?  If a lot, wider implants can be used with some risk for a double bubble but from my experience, the risk is not huge.  UHP implants produce different forces on your skin and its anticipated that you could get more stretch of the overlying tissues that would lead to more surgery in the future where a breast lift and downsizing will be mandatory.  If not sure about what you are being told, invest in a second opinion with a surgeon that won't limit your implant width by your own breast width... this is blasphemy to some surgeons but sometimes you have to do unorthodox things and I know can work well for the patient.

Tom J. Pousti, MD · Answer

Thank you for the question.  These days there are a variety of breast implants for patients and their plastic surgeons to select from.  This selection is usually made based on measurements of a specific patient's anatomy (dimensional planning) and after careful communication of a patient's goals.
The difference between these implants have to do with the dimensions (diameter and height) of the implants. For example, the high-profile implant has a greater projection and a smaller diameter compared to the moderate profile implant. The moderate plus profile implant as projection and diameter characteristics that fall between the moderate profile and high profile implants.
I prefer to have a wide selection of implants (all profiles) available in the operating room. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 
Higher profile breast implants tend to be especially useful for patients with relatively narrow frames,  although I have used high and ultra high breast implants for patients with wider frames as well. Again, much is dependent on the specific patient's anatomic measurements and aesthetic goals.   It is not true  for the use of a higher profile breast implant will necessarily lead to a "fake" (or less "natural" looking) outcome.   Other variables, such as the patient's anatomic starting point (how much native breast tissue is present), the exact volume of breast implant utilized and how/where the breast implant "pocket" is dissected ( among other factors) are also important.***Given your concerns, it is definitely worth spending more time (preferably prior to the date of surgery) with your plastic surgeon to discuss further.  One question that might be helpful to you: will you be more disappointed if you are slightly too small or slightly too big?  It will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
 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" or "slightly augmented look" 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 helps. Best wishes for an outcome that you will be very pleased with.

Richard P. Rand, MD, FACS (retired) · Answer

If your chest has been accurately measured, it is exceptionally narrow and maybe the only way to get up to the size you like is to go UHP. That said, it will give a very augmented "fake" look. HP is still quite full but smaller and more natural than UHP. You might want to visit another surgeon and be remeasured as I don't think I've ever measured a patient who is 5'6" and under 11 cm base diameter. If the real measurement is wider, you can go with a wider implant diameter and maybe not need to go UPH for the size. A HP might be just fine. Many surgeons get the BWD incorrect because they hold off at only the breast diameter, not the chest diameter which is the right way to do it.

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Dear Ms. Lala121899,
Thank you for your questions and story.  Unfortunately with out photos, a exam of your tissues and measurements I can can only comment based your photos. However I hope you find the following information helpful.
There are four different profiles (implant base width):
A) for the same volume the higher the profile the narrower the base width.
B)there is very little difference in projection between a moderate to high profile implantthus little affect on the perceptible final projection of your breasts.
C) the base width of the breast should equal the base width of the implant 
D)thus I personally chose the profile based on the patients chest measurements, (a high profile on a wide chest may not result in the cleavage desired and conversely a low profile on a narrow chest may result in implant in the outside arm area.
If implants are placed in the sub muscle position, use of silicone implants and moderate amount of breast tissue there is much less chance of breast implant palpability. 
I suggest you make out a list of your questions and select several nude "model" photos of what your desired goals/look would bring them with to your scheduled consultative appointments.
Please research that your Plastic Surgeon is Certified by the American Board of Plastic Surgery and ideally a I member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
My best wishes, 
R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
wwwimagineplasticsurgery.com
Awardee: RealSelf Top 100
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Is an ultra high profile implant right for me?

Answers (9)

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