Once the decision for breast augmentation has been made, the choice of which type of implant to use is one of the next important steps. The wide array of options can seem confusing at first, but in consultation with an experienced plastic surgeon, they can be narrowed down. Round implants now come in a choice of three profile shapes: high, moderate, and low. There are specific reasons for use of each type.
Ultimately, the process of selection is defined by:
1. desired size
2. the patient’s pre-existing anatomy
3. the desired shape and look.
The choice of size should be made on the basis of the patient’s desires in addition to the limitations of their anatomy. Most patients I see declare that they want a “natural” look, but that is largely subjective; in other words, the surgeon’s assessment may differ from the patient’s view, and others will have still a different opinion. We use the “cup size” method in order to discuss breast size, but everyone knows how unreliable this is. That is because the cup size system, introduced by the Warner Brothers Corset Company in the 1930’s relies on indirect measurements to infer the volume of the breast. It varies widely based as much upon the size of the person as on the breast.
Our practice is to have the patient choose the implant size by using a bra of the desired cup, then placing various sized sample implants into it. The patient has the final say over the size. The implant profile isn’t important at this stage, since the implants take on the shape of the bra, rather than the profile they will have after implantation. This step is for volume determination only. It is useful to remember, though, that implants typically appear up to 20% smaller after they are implanted. This may be because the look is different with the implant “stacked on” externally, as opposed to integrated with the breast into one unified shape. It is helpful for the patient to have more than one opportunity to try the implants on, so they will be more comfortable with the choice.
Pre-existing anatomy must also be taken into account when deciding which type of implant to use. For example, if the patient has a wide chest but desires close cleavage, the implants need to be large enough in diameter to avoid having an unnaturally wide space between the breasts. A woman with a narrow chest will require implants of a smaller diameter. If a breast lift is indicated, then still another variable is introduced. Different types of lifts affect the shape of the breast in different ways, and the implant profile can often help to counteract some of the limitations of certain types of lifts and improve the shape.
Breast shape is affected by several factors. The convention is to consider the breast as a static object only in the upright position, but in reality a natural breast changes with position and moves with activity. A perfect profile upright may look less ideal lying down or leaning over. Since round implants generally “behave” according to these criteria, they are the most popular type used. Once the round type is selected, the decision of which profile is best must be made.
The most important criterion for profile selection is the base diameter of the breast. This is easily measured by the surgeon with a calipers or measuring tape. The implant diameter must be less than the breast base, or it will be “squeezed” circumferentially. This will force it to scallop, or ripple around the outer edge, creating a range of other problems. Among these is visible rippling; I have observed much less rippling since the high profile implants became available, because the base diameter can be matched more precisely.