I wrote an email to a friend, and decided to paste the info here for anyone considering implants:
Choosing a doctor:
Go by their photos for sure - look at as many as you can. They often have larger binders of their work in office (way more than posted online), so you can get an even better idea. (If you interview remote doctors, see if they have more photos to send.) There is definitely an artistic aspect to it. Then check online reviews on realself and other sites. Go with your gut and go with someone who specializes in boobies.
Don't be afraid to meet with many doctors, even more than once if you have to. Come armed with a list of questions, get their opinions, and see who you trust the most.
Local is ideal because you can go in for follow-ups to address any concerns with scars, etc.
If they are pricier, in the end who cares. Go with the best. You only want to do this once, so do it right!
Sizing and projection:
You are limited by your breast width. So, if you have a narrow breast and want more boobage, you will have to go with higher projection, which looks and feels faker. the profiles are: low (rarely chosen), moderate (I have). mod+, high, and then *really* high (porn star like).
I actually wanted a low profile (I like flatter, wide, natural boobs), but my boobs are so narrow that if I got low profile, there would have been so little implant - it basically would have been like sticking two little hockey pucks in me. So I went moderate, which look good, but note that they never really "flatten" like real breasts. Again, someone who already has boobs won't mind because they have tissue above that is squishy and flattens, but mine never do. C'est la vie!
Don't be afraid to go 25cc larger. Try on the sizers in the office, and also use the rice bag trick (see online) and wear your new boobs for a while. Then, your surgeon will select the best size (from your range) once they are in there (assuming you have faith in your surgeon, which you should!). I was open to going up to 255CC, but he had to scale down to 225CC. I still would have liked them bigger, but my boobs were so narrow and he knew I didn't want projection. Make sure you explain very clearly the final look and profile you are going for.
Don't go by other's size numbers. It's all about body and breast width. Some women who got 350CC have boobs that look smaller than mine. The Dr. will help you understand what CCs will actually "fit" in your body. And in the end, a little bigger a little smaller - not really a big deal.
Above or below the muscle: Having met a few women who developed CC years later, I wanted to go under the muscle 100%. If you don't go too big in size, your doctor will only need to detach very little muscle. The recovery is longer (no lifting kids, etc.), but in the end a better result. Above the muscle is still popular, esp in Europe, because they move around more like real boobs. But my Dr. insists that as women age and their fatty tissues start to droop, the top of the implant becomes more visible. And then there is the statistically higher risk of CC. If you decide to go over the muscle, then consider the textured shell (Sientra if you can get them, since they've done a ton of studies and include a guarantee).
- Pros: less chance of feeling the shell. Less chance of rippling.
- Cons: are not "stickey" so, when under the muscle, higher risk of displacement, moving to your armpit, etc. Higher risk of CC when used *above* the muscle. This is because scar tissue forms in parallel strands around the implant, creating a shell that is more likely to cintract in a single direction. Below, muscle it's debatable = equal risk.
- Pros: Lower CC risk above muscle. Not all textured are created equal. Sientra textured is less gritty than others yet has been studied to create a nice scar matrix. So the scar tissue is forced to form stands in different directions. The theory is that because it is a more complicated matrix, in cannot "squeeze" into a contracture as easily. Also, less chance of implant displacement. But, as you know, mine dropped and I had to correct that (shoelaces) bc my tissues are so damn weak. But I'm the exception.
- Cons: Thicker shell that you can feel around the edges of your boob. I definitely feel around the bottom edges (bc my skin is so thin). Possible rippling.
Incision/scar: Infra-mammary incision i guess makes the placement easiest for the doctor. Plus you dont risk losing feeling in your nipples or strange scarring there. Even with my nothingness, I am fine with the little scars. My Dr. he had me use silicone tape 24/7 for at least 6 months (I still use it). It has been working really well, but there is still a faint scar. But I really don't care. I don't lie about them being fake :P
Feeling/seeing the implant: The more breast tissue you have and the thicker your skin, the less chances you will have of feeling the edges of the implant or having visible rippling. I had nothing, and tissue-paper thin skin, so I can feel the edges of the implant around the bottom of my breasts bc there is nothing there to cover it up. I have no rippling bc my doctor sized the implant correctly for my breast width and used cohesive silicone, which is firmer but helps to prevent rippling of the capsule (not as watery/flexible). Also, as I mentioned, textured are thicker and and more likely to be felt or ripple. Mine I can definitely feel, but fortunately they dont ripple. But hey - they're fake.
Types of fill: Cohesive silicone is safer, but I think it feels pretty damn firm. Anatomical implants for the most part use even firmer gel, FYI. If you have enough boobage, it's fine, but for someone like me, they definitely feel firm when hugging, etc. I wish my boobs were squishier (but there are issues with that, too). Some companies (esp. outside the US) offer softer silicone:
- Benefits: feels more natural/squishy.
- Risks: higher chance of visible rippling, higher chance of leaking undetected, which means you have to plan to get semi-regular MRIs to check on it throughout your life.
Shape of implant: I've heard of people being happy with both round and anatomical. Some people avoid anatomical bc of the risk of shifting angles, and over time, the round settle into the exact shape of an anatomical implant anyhow. That said, I might have benefited from anatomical bc the top of my round implants look pretty "round" when in a bra because, again, I have nothing above it besides ribs and tissuey skin. For a "normal" woman with some boobage or meat, I can see why there would be no difference.
Round: pros: if they shift around, it doesn't matter because they are round :)
cons: my situation: can look "round" if you go too big or have no layers on top.
Anatomical: they have a texture shell to help prevent shifting, but I hear that for some women they still shift, so then you have this weirdly oriented boob. The firmer gel can be even less squishy. That said, some women loves theirs, so look at online reviews if you are considering.
Healing: Very important to follow a healing protocol strictly, including sleeping positions, etc. My Dr. is anal retentive about this. The "rapid healing" method sounds a bit sketchy to me... If you choose under the muscle, it's even more imperative that you follow a strict healing regime because you do not want them to settle in the wrong position. My friend did not follow her sleeping protocol and one of her boobs is permanently displaced.
Other general thoughts:
1. In the end, THEY ARE FAKE and at times they will feel fake. It is what it is. They won't be perfect. But natural boobs aren't perfect either.
2. You are almost guaranteed to have a mental breakdown and feel regret. Just know that it will pass, you've done your research, and you will be happy. They're just boobs.
3. If you really hate them, you can get them taken out. Many woman have and they return to their original boobs in a few months. A little scar, lessen learned. Not a big deal in the end :)