Occasionally, during consultations, my patients have particular ideas about which implant profile they would like. For those of you who are not sure about what I am referring to, implant profile describes the way the volume within an implant is distributed in terms of its base width and the height (forward projection). A low profile implant is widest with the least amount of forward projection, and an extra high profile has the narrowest base width and the greatest forward projection. The base width is important also, because this is what gives you the desired “lateral projection” where the outer breast contour protrudes to the side of the chest to balance the width of the hips and give you the feminine. hourglass shape that women so desire.
So it would seem that many women would desire the extra high profile so that their breasts protrude forward the most. I tell my patients that on a computer screen during simulation, I can make their breasts protrude as far forward or as wide as desired. The reality is that this is nor practical nor desirable. Let’s look at the anatomy. The breast consists of the skin envelope which contains the mixture of glandular and fat tissue within the breast, also known as the “parenchyma” of the breast. All this sits above the pectoralis major muscle (see the diagrams in the “Implant Fundamentals” tutorial https://www.epsteinplasticsurgery.com/breast-implants-101.php ). So, if you place an implant under the muscle, the implant has to contend with the muscle, the breast parenchyma and the skin, all of which have to give way and move forward under the implant which is pushing them forward. The resultant breast size and shape is due to the sum total of the implant placed below and the existing breast tissue (and pectoralis major muscle) above.
Now, let’s look at the physiology of the interaction of the tissue and the implant. With all implants, I think it is safe to assume that there is going to be some atrophy (loss of parenchyma) of the breast. The more pressure from underneath, the more atrophy. If there is little pressure, then there is little atrophy. If there is a great deal of pressure, then there is going to be more atrophy.
Let’s talk about the high and extra high profiles first. I will lump them together for the purpose of this discussion, as my feelings about them are similar, but more strongly in the case of the extra high profile. These implants exert a fair amount of pressure to the underside of the breast. The atrophy can be substantial. So look at it like this, the more you think you are gaining with the higher profile, the more you are losing from your own tissues. So the gain is not as much as you might think. Besides the atrophy from the higher profile implant with resultant thinning out of the overlying breast tissue, there can actually be anatomical changes in the underlying chest wall – the rib cage. These changes can actually result in a depression of the rib cage, which, aside from being unnatural in appearance, also serve to reduce the net forward projection of the breast. This is an uncorrectable deformity.
In my extensive experience, I find that the medium profile implants work well in most cases…an excellent balance between width and projection. This results in beautiful, natural, aesthetically pleasing results.
What about low profile implants? When do I recommend them? Sometimes, the breast tissues are very tight and do not move forward as well as desired. This is common in some women with tight breast skin, little breast parenchyma – typically an “A” or an “AA: cup size who have never been pregnant, and even in some who have borne children. In these cases, sometimes even a medium profile implant might result in more pressure on the breast tissues then desirable. This is a great indication for a low profile implant. One might think that this will result in a breast that is disappointingly small or lacking projection, but in reality, the results are quite nice and aesthetically pleasing.
The take home message here is that in order to obtain the best breast which I define as the best shape and size, the greatest longevity of that shape, the least amount of tissue overstretching, the least degree of atrophy, the least damage to the nerves with loss of sensation of the breast, and the best chance of a 24 hour recovery, one must match the implant to the breast tissues. Neither you, nor your surgeon can force the breast tissues into a shape and size that they are not designed to accommodate. This means that in some cases, the patient may not be able to be the exact size they have in mind, but she will be rewarded with a beautiful, aesthetically pleasing result with longevity and recovery from surgery in 24 hours!
