Anatomical or round??? Was initially planning anatomicals but now not sure. (photos)

Initially went into my PS consult with the mindset of wanting anatomicals and we set out a plan for 335cc anatomical 410's under the muscle from under the fold. I have noticed some anatomicals looking more (for lack of a better word) droopy. My concerns: - if I do anatomical will they look droopy since I have quite an open chest? - would my nipples point down with round silicone implants? - wondering now if 335cc is too small? I am 5'6'' 130lbs and looking to go from small B too a full C

Doctor Answers 10

Breast augmentation

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You can get a nice result with either the round or the anatomic implants. The anatomic will give you a little less fullness in the upper part of the breast. It all depends on what your desired end result would be. Your breast footprint is actually a bit high. Look at where your fold is in comparison to your elbow and compare this to other pictures. 335 cc is a moderate augmentation on someone your size--would really need some idea of what your goal was to say if this was too big or too small. Even then, there is no substitute for the physical exam. Cup sizes are wildly inaccurate. I would suggest you get pictures of breasts you like and go talk to your surgeon again.

Milwaukee Plastic Surgeon
5.0 out of 5 stars 1 review

Breast Augmentation: Information

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RealSelf: 1 augmentation Dear Ms.

Thank you for your story and questions. Your desire for your final appearance
Should be clearly understood. Your anatomy, the filler material (saline or silicone gel) and shape of the implant all play a role in the final appearance.

Nothing substitutes for a personal evaluation and a face to face discussion of your options. Unfortunately without photos, a examination and measurements I can advise you in general terms, however I hope you will find them helpful.

I personally believe that It is important for prospective breast augmentation patients to understand what determines the appropriate implant size, filler material , shape and implant location. The final decision(s) is a personal choice guided by the experience of your Plastic Surgeon.

Your SPECFIC breast anatomy will dictate many of your choices. The breast foot print/base width on your chest will influence implant selection. Disregarding these measured dimensions will often lead to a more visable/conspicuous implant appearance.

As far as size you know all bras are not equal in "cup size" measurements.
"Cup size"is a very crude and non standardized measurement and varies by bra manufacturers. Thus actual cup size you eventually are measured at is not as important as your body proportions as it relates to your desired breast size
My specific responses are:
A)Realizing there are no standard bra (strap/cup) sizes, purchase several bras (full bodied and no padding) of the strap and cup size you think you want to be.
B)take a measuring cup (1 oz=30cc) place rice in a nylon. Therefore 10 oz. = 300cc...
C) try on various volumes of rice with some form fitting clothes.
D)if implant is placed under the pectoralis muscle I usually add 10% volume to what the patient chooses.... To compensate for the muscle pressing down on the muscle and for
the naturally settleing of the implant which often makes the breast appear smaller 2-3 months after surgery.

2) profile of implant:
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 implant
thus little affect on how the actual nipple will look.
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
E)Cleavage is largely determined by your anatomy. This can be optimized by choosing the best profile implant and postoperative implant displacement excercises towards the midline of your chest.

3)Shape of the implant:
A) for the vast majority of cosmetic patients I recommend round implants
B) reconstructive patients shaped/form stable implants are often used.
They are more firm as this is how they maintain their shape.
4)Placement decision of implant placement will be determined based on your anatomy, you current breast tissue, and your long term goals and benefits.

The four positions are:
A) Subpectoral which is completely under the muscle.
B) Supra pectoral which is above the muscle but under the breast.
C) Subfascial which is under the fibrous layer that covers the muscle.
D) Dual plane which is partially under the muscle and partially under the breast.

Placing the implant in the subpectoral or dual plane position I believe in general has significant benefits:
A) coverage of implant with muscle resulting in less palpability of implant (except in lower outer quadrant where ther is no muscle coverage)
B) less long term internal scar formation (capsular contracture).

5)Filler Material
A) silicone gel feels more like breast tissue, less potential rippling, comes prefilled cannot adjust size intraoperatively and larger incisions to place compared to equal sized (non prefilled) normal saline implants.
B) normal saline implants can be adjusted in size intraoperatively, if ruptures normal saline absorbs, potential increase rippling compared to silicone gel, smaller incision to place normal saline implants as compared to prefilled silicone gel implants.

I suggest you collect several nude model photos of the goal breast shape you desire and schedule several consultative appointments with Plastic Surgeons who are experienced and is Certified by the American Board of Plastic Surgery and ideally members 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
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Anatomical or Round?

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If a breast still looks "droopy" after augmentation it is not because of the type of implant. Shaped or anatomical implants have a slightly different look than round implants. The less breast tissue you have, the more noticeable the difference. An anatomic type implant will tend to look more natural with less roundness in the upper breast. 

Your breasts are somewhat ptotic (droopy) to start out, and they appear to sit lower on your chest wall. Some surgeons might suggest a lift, although it doesn't appear that a lift is clearly indicated. An anatomic implant has more volume in the lower part of the implant, and that can useful in filling out the lower part of the breast in a patient like yourself with mild ptosis or sagging. A round implant will not accomplish that any better. Much of your result will depend on surgical planning and operative technique. A somewhat larger implant to better fill out your skin envelope might be worth considering. The 410 is an exceedingly firm implant and would not be my preferred choice.

Anatomical or round??? Was initially planning anatomicals but now not sure.

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It is not possible to make specific implant size recommendations without an exam, but for patients with your anatomy, unless you want a very subtle change, we generally go with a round implant. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Anatomical or round???

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Different plastic surgeons have different opinions regarding anatomical implants. Some studies have shown that both plastic surgeons and patients, when shown photos of results and asked to tell whether the implants used were anatomical or round, could not tell the difference...they were only right 50% of the time. If a patient wants to have any upper pole roundness...not excessive...then they would probably be better off with a round implant. Anatomical implants are firmer because they must have a firmer more cohesive gel to maintain their shape, they are more expensive, and they have some risk of rotation which would require another surgery to correct. As to your anatomy, your low nipple position and breast overhang are borderline whether the implant alone will fill the lower portion of your breast out or whether your tissue will "droop" and hang off the implant and result in down pointing nipples. A breast lift would then be required to elevate the breast and the nipples. I think there is a reasonable chance that an implant alone may give you a good result, but it would require a dual plane technique to allow the implant the best chance of filling out the lower pole, and in my experience, a smooth implant will more reliably settle into the lower pole in these cases and help to avoid the need for a breast lift. This does not always work, and sometimes a later lift is needed, but in borderline cases in patients anxious to avoid a breast lift, it works often enough to be worth trying. Textured implants, anatomical implants or round, hold their position better but therefore may not work as well in these cases. Also, larger implants may be needed to fill out your loose skin...though it is not worth going larger than desired just for that reason. But it may be helpful to tell your surgeon that you would be willing to step up a size or two if it fills out your loose lower pole better, depending on whether your breast and chest width properly accommodates those sizes. Good luck with your procedure!

Anatomic or round

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Anatomic implants can help create some lift of the nipple and areola, but that lifting is marginal. In reviewing your photos, I'm concerned that a simple augmentation will not reposition your nipples to the ideal position. I would suggest discussing the need of peri-areolar breast lift with your PS. A second opinion consultation can also help. 

Arko Demianczuk, MD
Vancouver Plastic Surgeon

Breast augmentation

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I would suggest using 3D photographic imaging.  You can simulate the result with both anatomic 410 style implant and round implants before the procedure and choose the one you like the best.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 56 reviews

Anatomic versus round

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This is a great question! Anatomic versus round implants have long been debated and the recent American Society of Aesthetic Plastic Surgery this was heavily debated at the scientific session. The jury is not out on this question and the most important thing is making an informed decision and understanding the risks and benefits associated with any type of implant that can include things like rotation or contracture. Finding a board certified plastic surgeon that listens and understands your goals is the most important thing I can recommend! Good luck, MMT

What size and type of implant

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Allergan 410 type shaped implants, especially in the FF or FX styles in a patient with a relatively long chest can create the illusion of a breast lift. When you ask if the implant will look droopy, I think that both the 410 and a round smooth implant will not lift your breast in such a fashion that the nipple will be centered on the breast implant. At a consultation with a physician that has a Vectra 3-D imaging platform, you would be able to see the difference in what a round smooth implant versus a shaped implant would look like on you. You likewise could see what a lift would look like with an implant. For your situation, from what I see, a taller implant, if you're not going to have a lift will look better than a round implant.Depending on the size implant that you and your surgeon decide on, you may be a candidate to have a peri-areolar type of breast lift which limits the scars to around the areola. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Rounds vs anatomical

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Thank you for your question. The likelihood of your breast being droppy following an augmentation is higher if your breast have some ptosis prior to augmentation. In your case there is some ptosis to begin with. I think you can have an excellent result with both an anatomic and round implant. 

Best Wishes
Theodore T. Nyame MD 

Theodore Nyame, MD
Charlotte Physician

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.