How to choose between high profile implant and moderate, and between 350cc and 400cc? (photos)

Question

My breast length is 14cm and I have a large boney area between. I wear a 32A bra. I am 5'5" 120lbs and 30yr. I wanted the 400cc, but I worry that the moderate would be so close to my breast length (1cm smaller) that I would look heavy with boob coming out my armpit. My same worry with the high profile is that my boney gap would be more noticeable, and I would end up sticking out too far. I'm a high school teacher who teaches yoga/cross training. Will 350cc fit better? Will 400cc cause sagging?

David R. Stephens, MD · Answer

Hi smeather77; Y I think that you have the right idea and that you need some clarification about the result that you desire. I noticed with the photos of your breasts and the models you show, there is a photo of you in a push up bra. Can we assume this is result you are looking for? It seems you want round breast with a lot of fullness above the nipple; the breast fullness, say 40 percent above and 60 percent below. Also, the base diameter of the implant fits nicely in the "footprint" of the breast and there is good convexity in the shape. This is the look of an appropriately sized, "high profile", implant. Let's talk about why high profile in some cases and moderate in others: The most common situation when a woman wants to go with moderate is when a woman clearly wants a small breast where a moderate or even a low plus projection implant will give this goal. The other is when a woman is shorter but has a wider base diameter of footprint, a deflated "D" cup in a wider based breast, where a high profile would be a significantly large breast. The third is when a woman has a beautiful breast shape with a good amount of breast tissue and firm breasts; she will get a high profile breast, using a moderate profile implant. Deciding on the width or footprint is the first exercise in sizing. The next is deciding on the shape and projection that is necessary to provide the desired shape, whether it be "softer"/flatter, more "athletic" or "rounder" and fuller. The clue in most cases is the bra measurement. Take a 36 bra in a woman your height. Because the width/footprint of the breast is wider in this situation, she would need a wider implant for proportion. Your footprint being narrower needs a narrower implant. Simply put, in any projection style, (whether it be low, low-plus, moderate, high or super-high), a bigger size means wider. I think you get that, right? ...BTW, your worries are not unfounded, at least from the information you are giving us, that is you are a 32 bra size. I would think that you need a narrower base diameter implant....The gap between the breasts depends on the natural boundary of the breast and any implant, regardless of the projection, will fit within this. The angle of breast skin coming off the natural breast fold will be different based on the implant projection. In your case, the difference between a high profile and moderate implant with a smaller breast and minimal breast tissue, is not a lot, probably 40 to 60 cc's of volume and less than a centimeter of projection difference.But this needs more clarification; we use our Vectra 3D imager which can help take the guesswork out of the conversation as you see your body with different widths and projection styles of implants.

John Diaz, MD · Answer

It is very difficult without assessing you in person to if the implant size you mentioned will be a good size for you. Keep in mind that implant size selection not only depends on your personal preference, but it also depends on your unique measurements. There are various types of implants that can help you attain the look you are going for. A thorough consultation with a board certified plastic surgeon will allow you to communicate what your desired result is and will inform you as to what is possible to achieve your goals. We have a device called the Vectra 3D imaging system that shows you what you will look like with any implant. Our patients are very happy with the choice of implant they make when using this system. To learn more about breast augmentation, you can read “A Comprehensive Guide to Breast Augmentation."

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.
  
The size of implant 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.
  
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

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. 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 breast surgery. Hope this helps and good luck with your surgery.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. I think that you have a great starting point and will do very well with breast augmentation. You would likely be happy with either choice if implants. The higher the profile, the more of an augmented appearance you tend to have. Also consider the lower profile implant will give you more width and height to the implant, so this will provide more medial fullness and cleavage plane, but will also produce more lateral implant excess too as the implant will be centered underneath the nipple. I think that the goal pictures you show are certainly very augmented and probably more in line with a high profile implant with large volume. In addition, while you say that your "breast length" is 14 cm, I assume you mean width and I would doubt that based on your pictures, you are really that wide. You want to make sure you are having this measurement done by an experienced plastic surgeon because this is important to pick your implant. This is a decision that ultimately needs to be made by you and your plastic surgeon together based on your goals. Best of luck!

Hetal Fichadia, MD, FACS · Answer

Thank you for your question. You are at a great starting place and should have a good result with breast augmentation. Choosing an implant has evolved from volume-based to tissue-based and dimension-based planning. This means that detailed measurements and specific anatomic features like thickness and elasticity of overlying breast tissue are considered while choosing an implant. There are a few things that you can control to ensure a good outcome. Find a board-certified plastic surgeon who you are so comfortable with, that you can talk to them in detail about your goals. Bring your wish pictures, try out some implants in the office. Unfortunately, this is one area where online recommendations are not that valuable as they don't involve a detailed exam and discussion about your goals. 
Good luck with your search!

Austin Hayes, MD · Answer

Thank you for your question. Based on your photos, you appear to have a nice starting place and should have a nice result with breast augmentation surgery. As you increase the profile of the implants, your look will become more "augmented" and less natural. I typically use moderate profile implants and sometimes low-plus profile to get the most natural look. However, the most important factor when sizing implants, is working closely with your surgeon in person to find the implant size that gives you the look that you desire. Careful measurements of your breast and chest wall will help determine which size implants will fit within your natural breast footprint. Taking into account your desired look, and your measurements, an implant is chosen that specifically fits your body. Unfortunately, online recommendations are not that helpful. Make sure that you have a good relationship with your plastic surgeon, so that you two can work together to find the right size. In my office, patients try on implants in a bra and clothing. There able to see how they look in the mirror, and in photographs. Women are also encouraged to bring in wish pictures, so that I can get a sense of the look that they would like to achieve. Good luck with the process!

Daniel Barrett, MD · Answer

Dear smeather77,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, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.
With regards to your specific question, I would not marry yourself to a particular volume. Use your BWD as a starting point. Within that measurement, there will be different volumes at each profile. A higher profile device will give greater volume and more projection at the same width compared to a moderate (+) profile device. If you are leaning towards a more conservative result I would recommend sticking with the moderate (+) profile device and sacrificing the volume. 50 cc is subtle and is the equivalent of the volume in a shot glass.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

William Andrade, MD · Answer

Hello, your concerns about matching your implant dimensions to your base width are valid.  Every surgeon will have their own recommendations regarding ideal implant selection so I would recommend discussing your concerns with your surgeon.  I personally suggest my own patients choose implants that are not as wide as their breast base width to ensure there is adequate coverage.

How to choose between high profile implant and moderate, and between 350cc and 400cc? (photos)

Answers (20)

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