Can the 45/55 ratio be achieved with large high profile implants? (650-700 cc)

Question

My doctor measured and advised me to go with high profile implants since I want a larger size (650-700 -and yes, I'm tall/heavy enough to pull it off) saline, under the muscle, inframammary incision. I did want to get opinions on if the 45/55 ratio (regarded as the "ideal" ratio of breast tissue above/below the nipple) is easily achievable with this placement of implant? Thank you, in advance.

Ronald J. Edelson, MD · Answer

The proportion of the implant that ends up above the nipple versus below is dependent on many factors.  The most important factor is the shape of your breast beforehand as well as the amount of greats tissue and how the tissue is distributed throughout your breasts.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.An in-office consultation with precise measurements of your breasts is necessary. Then, those measurements need to be compared to the dimensions of the implants that you have selected.

To be sure, see two or more experienced,
board-certified Plastic Surgeons for a complete evaluation to make sure you are
a good candidate and that it is safe for you to have surgery.

I hope this helps.

George John Alexander, MD, FACS · Answer

This question would be hard to answer specifically for you without
knowing your existing anatomy.  The 45/55
ratio describes a look that is more “natural” meaning that there is fullness
overall but when not in a bra there is some slope to the
top of the breast and more fullness to the bottom of the breast.   All
types of implants can achieve results like this but there are many
variables.  The best doctor to give an
idea of your results, is your board certified plastic surgeon.

Robert Singer, MD · Answer

What is more important than any specific artificially determined "ideal" ratio, which may or not be achievable in any particular patient, is the overall desired  cosmetic outcome.The best
cosmetic result in any particular breast augmentation patient depends on a
variety of factors, including: Your individual anatomy, realistic expectations,
a thorough discussion with the plastic surgeon about the options, and an
understanding of the pros and cons of any particular implant choice. Proper
sizing is not just about the number of cc’s. The thickness of your tissue,
breastdimensions which include the width,
height, and projection, as well as chest wall width all need to be considered
when choosing an implant. Trying on implant “sizers” of various shapes and
volumes while wearing a tight t-shirt, bra, or bathing sit at a preoperative
visit will help you and your surgeon choose the optimal implant.

There are no manufacturers' standards for cup sizing in the bra industry. The
cups of a 32 F and a 38 F are significantly different. Cup size varies from
manufacturer to manufacturer and even within styles from any particular
manufacturer.

Keep in mind that following the advice from a surgeon on this or any other
website who proposes to tell you exactly what to do without examining you,
physically feeling the tissue, assessing your desired outcome, taking a full
medical history, and discussing the pros and cons of each operative procedure
would not be in your best interest. I would suggest that your plastic surgeon be
certified by the American Board of Plastic Surgery and ideally a member of the
American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are
comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Justin West, MD · Answer

I wouldn't spend too much time worrying about the 45/55 ratio. Your surgeons job is to make sure you get the best result possible. We have been doing this for millions of patients since well before a handful of people decided to write a paper on the subject. We take time to measure patients to figure out what range of implants will best fit, but there is no formula for picking the perfect implant. Your surgeon will likely place sizers first, and fill to different volumes to figure out what size or style looks best on you. The suggestion I would make is to give consideration to silicone implants. They tend to give a softer feel and you will be less likely to see rippling. These issues will bother you far more than not having the "perfect ratio." Good luck with your surgery.Dr J

Ronald V. DeMars, MD (Retired) · Answer

The answer is "Of course, in some patients" but there is no way to give you an answer regarding your situation as we have no idea what your anatomical issues are.

Thomas M. DeWire Sr., MD (retired) · Answer

CurvyPinup,Whether that ratio can be achieved is going to be determined more by the existing ratios, and whether or not the inframammary fold position can be changed to create that ratio, if it is not the one that you already have.   Implants basically will increase the size of your breast, but not its geometric shape and geometric ratios unless the fold position can be widened and/or lowered. However, lowering the fold is not possible in all patients because of fold geometry, and how defined the folds are in the pre-op state. Lowering well-defined folds and recruiting tight tissues from below the folds into the breasts will lead to double fold deformity, especially if the pectoralis muscles are cut during submuscular placement.  This needs to be considered in your though process and discussed with your surgeon.  Narrower implant can be placed in a smaller base footprint, lessening the need to expand or lower the folds, sometimes allowing more volume without deformity.  I hope that this helps.  The link below discusses how the starting point shape impacts the outcome of augmentation.  Best wishes,    Tom DeWire, MD, FACS    Richmond, VA

Can the 45/55 ratio be achieved with large high profile implants? (650-700 cc)

Answers (7)

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