Surgery in 4 days! Sientra 470cc HP or Allergan 475cc HP?

I prefer Sientra textured high profile cohesive gel implants in this case. I believe there is high quality data from clinical trials indicating that patients have fewer problems and reoperations with the Sientra gel implants. Good luck. 

They are both great companies.   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

At size 32, each 100
cc of implant corresponds to 1 cup size change. 
If you are a B, 200 cc will take you to a D.  470 cc implants weigh over 1 b each and will
result in breast descent.  You are most
concerned about implants but you have ptotic breasts that are too low and you
need a lift.  The technique I recommend
is a modified Benelli.  Using a
circumareola incision, your breast tissue is reshaped creating upper pole
fullness, elevated higher on the chest wall and more medial to increase your
cleavage.  At the same time, small
implants can be placed retro-pectoral. 
Aligning the nipple, breast tissue and implant will maximize
projection.  Best Wishes,Gary Horndeski, M.D.

Thanks for your question. Unfortunately, it is impossible to give an accurate assessment and plan without performing a formal history and physical examination. That being said, in reviewing your photographs, you may benefit from breast lifting in addition to augmentation. Placing large implants during a lift procedure can make final results less predictable and increase risks. In regards to implant size selection, I suggest that you rely on actual patient pre and post photographs. The gallery at the "breast implants by mentor" website would be a good place to start. Find patients that are representative of your goals and share these images with your surgeon. Clear communication with your physician will be critical in achieving a good outcome. Best of luck!

It's a great question. It's difficult to give specific sizing recommendations without an in-person consultation. If you feel that both implants give a similar look, then I would choose the implant with the better warranty. However, your goal look should be the number one factor. I agree with Dr. Rand regarding large implants combined with a breast lift. The implant stretches your breast skin, while the breast lift is meant to tighten it. These competing forces can lead to complications. Also, large implants will lead to more stretching and sagging with time. It's important to speak with your surgeon regarding the pros and cons of large breast implants when combined with a lift. Good luck with your upcoming procedure.

Hi gymdiva1903,

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.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

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, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, 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.Based on your photographs (and goal pictures), I would be concerned that you will not achieve the desired outcome with breast augmentation surgery alone; breast lifting seems to be indicated.   Again, make sure that you and your plastic surgeon are on the same page when it comes to achieving an outcome that you will be pleased with (in other words, make sure that you have realistic expectations…).
 
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
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” 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. 

Dear gymdiva 1903,
Many thanks for your question. I would be slightly concerned that 4 days out from surgery you still do not have an implant manufacturer finalised - this in my opinion should have been sorted in the office before surgery was booked.
I have never used Sientra implants and since all the data started coming out regarding BIA-ALCL have not used Allergan implants - as I believe is a common finding here in the U.K. and beyond, but I have no knowledge of the market in the U.S.A. This is something that you should discuss with your Board Certified Plastic Surgeon.
You should pick your implant based upon the experience of your surgeon in recommending an implant that will help you achieve the result you want, the safety record of the implant and also on how the implant feels to you. A warranty is a bonus but not one to base your final decision on.
I wish you luck.
Best wishes,
Marcus

Dear Gymdiva1903,Hello and thank you for your excellent question. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. You are an excellent candidate for a breast augmentation.  The size, profile, shape, texture, and type of implant (e.g., saline, silicone, “gummy bear”) is based on your desired versus existing breast size and shape, your chest wall measurements, and soft tissue quality. It is essential that you have an in-person consultation to develop a treatment plan that specifically addresses your personal surgical goals, and your body’s anatomy. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 - 2018

 I understand your anxiety with your upcoming surgery. The implant should be chosen based on which one will look the best on you not on the warranty. Hopefully you’ll never need the warranty. The only other issue I may raise if you were my patient is whether or not it is best advised to do a full lift on somebody with a very substantial implant at the same time. The stretching forces of a large implant battling against the tightening forces of a lift lead to substantially higher complication rates in national series. While many times patients get away with this process, sometimes they get into higher risk of revision. Separating them by four months seems to me to illuminate the battle between the stretching and the tightening forces and either of the two surgeries can be done first. That’s just my personal opinion though.