Many times during a Breast augmentation consult a patient will say to me: “I want to look proportionate.” In other words, the patient wants to make sure that a particular implant size will look right on her. The right proportion is determined by several factors. A good proportion is not only determined by the size of the implant; it has a lot to do with the relationship of breast implant shape to the shape of the woman’s torso. Thus, in addition to the size, another way to achieve proportion is by varying the type of projection.
Breast implants come in many shapes, but the vast majority of implants used in cosmetic surgery have a round base. Round implants, when viewed from the side, have a certain height. This is called projection, because when the base of the implant is placed on the chest wall, that height projects out. There are two ways to increase projection in an implant. The first way is to add more volume to the implant. For example, in a saline implant you can add some projection by injecting more saline into the implant. However, saline implants do have a fill limit. If too much saline is injected, the implant will feel hard. On the other hand, a silicone filled implant cannot be adjusted because it has a fixed volume of silicon. You can not add saline to a regular silicon implant.
The other way to add projection is to make the base (diameter) of the implant smaller. Thus, for any given volume, a smaller base has more projection. This is what “high profile” implants do – they have a smaller diameter with a higher projection. Think of what happens when you pour the contents of a glass of water into a soup bowl. In the glass, the volume of water has a small base (the bottom of the glass), but is rather tall (projection). In the soup bowl, the volume of water has a wide base (the width of the bowl), but is shallow (very small projection).
Let’s take, for example, the 350cc implant in the picture above. The moderate profile implant has a wider base when viewed from the top. The high profile implant has a smaller base. When viewed from the side, the high profile implant is taller (more projection). The moderate profile implant will appear distributed over a larger area on the chest wall, but will project less. There will be a smoother transition between the upper chest wall and the volume of the implant. The high profile implant will have a more noticeable transition between chest wall and implant, and it will project more. Neither implant is “better” than the other. What is critical is educating the patient about how each type of implant affects the look she is trying to get.
For example, take a woman with a narrow chest wall. If she thinks she looks too small on top compared to her hips, she may want to consider a moderate profile implant which is wider and will restore some balance with her lower body. If, on the other hand, she wants a large cup size, but not necessarily a wide appearance on her torso, she is better of with a high profile implant. The high profile implant will also create more fullness in the upper pole of the breast. If the patient has sufficient breast tissue thickness to wrap around the implant, it reduces the chance that the higher profile will look too artificial.
A woman with a wide chest wall will be better off with a moderate profile implant, and if she wants more projection, she should go for a larger moderate profile implant.
These guidelines are not absolute, as some patients do like very pronounced cleavage, in which a high profile implant is more likely to create the desired effect. On the other hand, if a patient just wants to “fill out” the volume lost as a result of age or pregnancies, I’m more likely to recommend moderate profile implants.
As a patient you should be aware that you have a lot of alternatives beyond “I want to be a C cup.” You can pick the type of implant that is most harmonious with your body type and creates the best overall proportion. I always discuss these implant choices in great detail with my patients prior to their breast augmentation surgery. And you should discuss all of your options with your board certified plastic surgeon, too.
