How Does Sizing Affect a Low Profile Implant?

Question

I want a very natural look and have little breast tissue. My PS suggested a LP silicone implant that seems wider than my breast base, but I know that placing implant under the muscle means that it will look smaller than it does in the office. What happens if you go too big with a low profile implant. Does the extra volume stick out at the side or should I trust my Dr. to go slightly bigger than I think I want?

Larry S. Nichter, MD, MS, FACS · Answer

The shore answer is: Find the best plastic surgeon available, let him know clearly what you want to achieve and let him/her make the decision on the best implant choice.It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below.

Otto Joseph Placik, MD · Answer

You should not choose implants that are much wider than your natural breast width. Lower profile implants are flatter, while higher profile implants project further out. Lower profile implants do provide more cleavage.

Hayley Brown, MD, FACS · Answer

I rarely use the lowest profile implants in silicone. You are right, that under the muscle you will loose some projection. Silicone implants in the appropriate size for your frame typically look natural. It is important to pick an implant diameter that fits within the width of the breast. If it is too wide (wider than your breast width), it could stick out a bit laterally. I would trust that your doctor is taking accurate measurements to assure that you are choosing an appropriate size. Sometimes the narrower, midrange profile implants do look more petite and suit patients who are narrower, while maintaining naturalness.

Tom J. Pousti, MD · Answer

The use of sizers in your bra  preoperatively does not accurately correlate with the size of breasts achieved with sub muscular implants. I think that it is very important that you communicate clearly with your surgeon to maximize the chances of achieving your desired breast size.

	In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; means different things to different people and therefore prove unhelpful.

	Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

	I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. 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.

	I hope this helps.

Beverly Friedlander, MD · Answer

Low profile implants are best used in women who have a broad chest, and don't want a lot of projection or a fuller size . Lo profile implants tend to be wide and are uncommonly used. Without knowinf the specifics of your case, that is your height weight current bra size and chest dimensions, it is difficult to comment on your specific needs.

David Bogue, MD · Answer

Sizing of implants is very important. Many complications in breast augmentation can be avoided by choosing the correct size and shape in relation to a woman's natural anatomy. I discourage the use of implants which are wider than the breast width. This is for several reasons:

	
		Overly wide implants increase the likelihood of symmastia which is an unnatural violation of the middle portion of the chest by either the breast tissue or the implant
	
		The implant may ride underneath the arm which is a common complaint from women with overly wide implants
	
		Placing an wide implant into a narrow pocket may lead to excessive folding of the implant and possible early rupture
	
		The implant can become palpable and may lead to a higher risk of wrinkling and tissue thinning


	Implant projection allows for varying volumes for a given width. To give an example, a Mentor 300cc moderate profile (which is essentially a low profile) silicone gel implant has a width of 13.5cm and a height of 3.0cm. In the moderate plus which is only 3.6cm in height (6mm difference), the same 300cc volume has a width of 12.0cm.

	All these measurements are important because the goal of augmentation is to accentuate the natural breast. Keeping the implant within the anatomical confines of the breast allows for better concealment of the implant while still increasing the size of the overlying breast. If you are uncomfortable with the explanation from your surgeon for his implant recommendations, I recommend seeking a second opinion. Having an operation performed correctly the first time is always preferable to a revision operation (and usually less costly).

Peter A. Aldea, MD · Answer

Regarding: "How Does Sizing Affect a Low Profile Implant?
	I want a very natural look and have little breast tissue. My PS suggested a LP silicone implant that seems wider than my breast base, but I know that placing implant under the muscle means that it will look smaller than it does in the office. What happens if you go too big with a low profile implant. Does the extra volume stick out at the side or should I trust my Dr. to go slightly bigger than I think I want?"

	WOW!  You Think and express yourself like a Plastic surgeon. As a matter of fact you have already demonstrated that you think better than your surgeon.

	To obtain an attractive augmented breast we must augment the existing breast by placing an implant that is maximally covered by the existing breast tissue and which sits on the flat portion of the rib cage without falling sideways and constantly doing battle with the forward moving arms.

	Low profile implants are rarely if ever used by most surgeons. When they are used it is in women with very wide chests who want a minimal augmentation but who want more of a narrowing of the distance between the breasts. The MOST popular implants are the Moderate Profile (Allergan) or Moderate Profile Plus (Mentor) saline implants. I prefer using the Mentor High Profile silicone gel implants because they are MUCH more similar to the Moderate Profile saline implants than the High Profile saline implants. These implants offer a nice projection to the breasts with a relatively narrower base / foot print than the low profile implants.

	Since ALL breast implants ripple, covering these implants with soft tissue is important in hiding these ripples and folds. That is why we put them under the muscle and the breast tissue. As larger implants are chosen which are NOT fully covered, the ripples are felt and in thin skinned women, become visible. While silicone gel implants do ripple LESS than saline implants, they ripple nonetheless.

	So - ask yourself? How much palpable and visible breast rippling are you willing to accept in order to have larger breasts (in which the implants are larger than the amount of breast cover)? Once you have answered this question you will KNOW which way to proceed. Personally, I would get at least another if not more second opinions.

	Good Luck.

	Dr. Peter Aldea

Steven Wallach, MD · Answer

Low profile implants tend to be wider than the other implants on a volume per volume comparison.  I personally  use these implants very infrequently.

Darryl J. Blinski, MD · Answer

I agree with your thoughts and rarely ever use the PL implants for those reasons you posted. I would consider a HP and seek a second opinion from Dr Scott Spear at Georgetown in your area. Best of Luck.

Peter E. Johnson, MD · Answer

Breast implant profile or 'projection' varies from low, moderate, to high and indicates the height of an implant of a given volume and diameter. A low profile implant make a perfect sizer as the implant will conform or project further as the base diameter is constricted. The quality we like so much in the low profile implant is the fact that it will flow well and feel natural within the breast. If the breast is 12 cm. in diameter and the surgeon makes a pocket to match the breast size, a 13 cm. low profile implant will become 12 cm. and project a bit more, 'round up' to fit the space and offer the potential for greater flow and softness and flexibility. As you go bigger with the low profile implant, say in our example 14 cm., it can tend to form a fold, and the moderate profile implant becomes a better choice. Also if the implant does not fit the breast, the lower profile implant may have a greater tendency to push to the side or below and not fit hand in glove. Keep the look you want fixed in mind, and show the surgeon through photos the look and feel you want. Leave the sizing to us.

	Best of luck,

	peterejohnsonmd

How Does Sizing Affect a Low Profile Implant?

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