Back in the dark ages, plastic surgeons recommended breast implants based only on their total volume.
Now, most modern surgeons realize that it is important to measure the patient’s rib cage width, and match the width of the implant to the width of the patient, in order to obtain a result that looks attractive, proportional, and avoids an overly wide cleavage gap or excessive lateral (side) fullness.
In addition to picking the right size, there are several choices of implant shapes available. These are called “profiles” by the manufacturers. Choosing the right profile makes a major difference in the final appearance of the breast shape.
Many patients are unaware of these possible choices before their consultation with us, and have only thought about the number of cc’s in the implant or the cup size they want. A useful question to consider is “How much fullness do you like in the upper part of the breast?” Someone who want a lot of fullness will pick a different implant than someone who just wants a little.
The most popular profile (implant shape) in our practice, whether it be silicone or saline filled, is a medium profile implant. About 70% of our patients choose this shape. It gives an attractive fullness in the upper part of the breast, but not “too much” for most people’s taste. I call this the “Victoria’s Secret catalogue model” look, and the proportions work well for most average frame patients.
The second most popular profile is the “high profile” implant. It gives more roundness and fullness in the upper part of the breast. For women that have a narrow ribcage and still want a generous implant volume, the high profile shape is worth considering. For women that want a larger, fuller implant without going to a wider implant, sometimes switching from a medium profile to a high profile implant is also a useful option. About 20%-25% of our patients choose this shape. But it’s a “love-it-or-hate-it shape”; some women think it looks a little too overdone or obvious, especially in the larger sizes, while some women find it sexy and attractive. It’s all personal taste.
The low profile implant is the third choice. It works for women that have a broad ribcage, but for whom the other profiles would give an implant volume that would be excessively big. It’s a more conservative and “natural” look, and gives less projection or upper pole fullness compared to the other two profiles.
While some surgeons strongly recommend high profile implants for women considering a combination breast augmentation / breast lift surgery, I do not insist that women make that particular choice. It is true that a higher profile implant has a greater arc length over its highly curved surface, and so it fills up more loose skin compared to the lower profile implants. However, the patient may not want the size or shape that a properly selected high profile implant gives. I think its more important to the final result to pick the implant size and shape that the patient wants first, and then tailor the mastopexy around that as needed. In my opinion, this is much more likely to make the patient happy in the long run.
In our experience, there’s no substitute for proper measuring, followed by trying on actual implant sizers in a sports bra and T-shirt. Once women see how it looks in the mirror, it’s amazing how rapidly they are able to sort out the many different choices. Once they see the look they prefer, most women know it almost immediately! It’s kind of like trying on shoes: you know if they fit or not.