In discussing implant choice with patients at the time of consultation, I am frequently asked whether I could use a “high profile implant.” I try to answer this question by explaining the purpose of implants with different “profiles”, and why this is a confusing and badly named system. I prefer the descriptions moderate, narrower and narrow base. Most plastic surgeons today use an approach to size that takes into account more than volume (cc’s), but most patients ultimately think volume equals size after hearing and reading about everything else. (“My friend had 350cc’s and I like her’s”).
Implant volume vs. shape of breasts
Implant volume is only one factor. How much breast tissue you have before surgery is very important. The shape of your breasts before surgery is the most important factor determining the shape of your breasts after surgery. Beyond implant volume and your natural breast shape and volume there are the dimensions of your chest. We try to fill the space between the edge of your armpit and the side of your breastbone to give as natural/ beautiful a look as possible.
Here is where moderate profile, moderate plus profile and hi-profile (Mentor Medical’s terms) play a role. If your chest is relatively narrow, and you ask for a relatively large volume, to fit that volume onto the space available, we need to use a higher profile ie narrower base implant.
On the other hand, if you want a modest implant size and your chest has a greater width, you will need a standard “moderate profile” implant to fill the space out and not have too narrow an implant with too much mobility when you lie down.
During the initial consultation I take certain measurements that are useful in the sizing process. We look especially at the distance from the nipple to the crease under the breast (NAC – IMF) and the base diameter (distance from breastbone to armpit edge), as well as how far the nipple is from the top of the breast bone (SN – NAC). When my staff and I size my patients for breast augmentation, we want to fulfill an idea each woman has in her mind, of her ideal. Sometimes this isn’t possible because her desires aren’t realistic, but usually we come pretty close.
The fitting process
Generally speaking, we try to get an idea of what size you have in mind first, by putting you into a standard bra of the band width and cup size you desire. The band width is what you should be wearing now, though many women wear the wrong size according to professional bra fitters. Your natural breast occupies some of the bra cup, but the cup is partly empty. Then we fill the bra cup to the degree of fullness you desire using an inflatable device and measure the volume we have added. Most of the time we add enough volume so you feel it is too much and then reduce this slightly. For some women, who fear being too large we add only enough to make her feel comfortable. If the volume you desire is high, so that a moderate profile (ie. normal diameter) implant wouldn’t have enough room, we use a narrower base/ diameter implant. I may choose a mod plus or a high profile implant, depending on the volume and base diameter as well as the nipple-to-crease dimension.
There are now some approaches to sizing which use 3D imaging techniques to try to show you the effects of augmentation. While these technological advances are attractive sounding, I abandoned computer imaging in the past when I found it was far more useful as a sales tool than as a true predictor and as a patient educator. Only time will tell whether this technology is a true advance, as attractive as it may sound. Ultimately, you always need to make a small leap of faith, in order to proceed with elective, cosmetic surgery. No approach to sizing will tell you exactly how you will look, or how happy you will be.
While all this sounds terribly complicated, it really comes down to a matter of balance. We balance the volume desires with the physical dimensions and come up with the best possible combination of those factors. Sometimes this may mean adjusting the volume of the implant up or down a little, and the final decision on exactly what implant needs to be used will be one I will need to make. Ultimately, it will be with the aim of giving you the greatest chance of satisfaction.