375cc or 400cc high profile?

Question

I am 5'0, weighing at nearly 100lbs. I had breast aug done before with 350cc mod, saline overs. Results wasn't as full as I wanted in upper pole, that's why I'm switching to HP silicone. Unfortunately I developed capsular contracture. I'm debating between 375 or 400 for reconstruction. I really like the bigggg big sizes, but every now and then I feel like I would completely "all boobs" theoretically speaking.

Vincent N. Zubowicz, MD · Answer

Very few women lament being too larger after breast augmentation. Almost all, however, wish they had gone a bit larger.  Opt for the larger set.

Luis Villar, MD, FACS · Answer

The idea that "Implants placed above the muscle have no means of support. They will eventually make their way down your chest wall and stretch your tissues where you will need a lift sooner than later", is not based in fact or sound science.  The placement of implants over or under the muscle depends on the type of implant and the anatomy and tissue quality of the patient.  Some patients with very wide insertion of the pectoralis muscles (wide cleavage) will have their condition worsened by implants under the muscle. As the implants enlarge the medial attachments of the muscle force the implants into the armpits.Patients with tight cleavage and elastic tissue can get equally good looking results at rest.  When you flex the pectoralis muscles, implants under the muscle will get the jumping breast deformity to varying degrees, as a trade-off for going under the muscle.  Capsular contracture is a game changer in revisions because the recurrence rate is high and can distort any gains that may have been achieved by re-operation.As a general rule I do not predetermine implant size.  I would perform a complete capsulectomy and evaluate what I have left to work with. I would then decide what shape and size is best suited by placing sizers at surgery.  In these cases less is better as a starting premiss.

Farbod Esmailian, MD · Answer

This is how I would approach your situation:  Given your history of capsular contracture and implants that are subglandular, I would likely begin by placing the implants behind the muscle.  Next, we would determine your base diameter and stay within the confines of that measurement to help avoid additional surgeries in the future.  This may mean that you will need a high profile implant to get a meaningful augmentation given your small stature.Hope that helps, good luck!

Gary M. Horndeski, MD · Answer

I suspect that your happiness with either the 375cc or 400cc will be shortlived. Implants placed above the muscle have no means of support. They will eventually make their way down your chest wall and stretch your tissues where you will need a lift sooner than later. I understand you like large implants; please be prepared for a lifetime of corrective procedures if you move forward. My suggestion is to choose smaller textured silicone implants behind the muscle. Hope this helps.Good luck,Gary Horndeski M.D.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.It is difficult to say without pictures. In my experience, you may not notice the difference between the 350 cc that you have and increasing by only 25 cc.

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.

Robert M. Kachenmeister, MD · Answer

Without reviewing your pictures it will be difficult to give an accurate opinion but 400cc on your frame of 5 ft and 100 lbs is probably about as large as you would be comfortable with. Secondly, the difference between the 350cc implants that you currently have and the choices of 375cc or 400cc will be only a moderate increase. Probably the better measurement to take into consideration will be the base diameter of your breast and the size/diameter of the implants you are considering. In light of your capsular contracture you may want to consider textured silicone implants. Best of luck.

John J. Edney, MD · Answer

It is difficult to answer this type of question without the ability to examine you or view quality photographs.  It would also be helpful to know what the base diameter of your breast is.  Knowing the base diameter would contribute important information necessary to choose the best implant for your goals.  At 5 foot 0 and 100 pounds it is not likely that you have  very wide-based  breasts.  Consequently the choice of implants will be somewhat limited.  Very likely a high profile implant will be appropriate and placing them under the muscle is a good idea especially considering that you previously had a capsular contracture when the implants were placed above the muscle.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced.  Good advice would necessitate much more information and a much more thorough communication of your goals. For example, given the complication, I am hopeful that you are planning on breast re augmentation in the sub muscular position. When it comes to selection of the optimal breast implant size/profile to achieve your goals, I would suggest that you spend more time communicating your goals carefully with your plastic surgeon. In my practice, I would ask that you use as many visual aids as possible during this communication process. For example, goal photographs may be very helpful.  On the other hand, I ask patients to avoid potentially confusing terminology such as “C or D cup” or phrases such as "natural" or “big sizes” or “all boobs”. Then, in the operating room, I find the use of temporary intraoperative sizes very helpful; having a complete selection of breast implant sizes/profiles available allows for the selection of the breast implant most likely to achieve the patient's goals precisely.Again, generally speaking,  careful selection of plastic surgeon and careful communication of goals are the 2 most important factors when it comes to successful breast augmentation or revisionary breast surgery. Best wishes for an outcome that you will be pleased with long-term.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question but I am more concerned about your capsular contracture then the relative small difference in implant size.  I would carefully discuss my options with your surgeon regarding the treatment of capsular contracture so as to avoid it in the futureDr Corbin

375cc or 400cc high profile?

Answers (9)

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