Breast implant profile refers to how much it projects off the chest wall. In the past, the only available design was the moderate profile implant, which is now considered the normal or standard projection.
But nowadays, patients have other options that include low, moderate Plus, high, and extra high profile implants.
High profile implants stick out more, giving an illusion of a bigger breast. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that women with a narrow chest are often a good candidate for such design because it occupies just the right amount of space.
Dr. Smiley has recently posted high profile breast implants before and after photos on his Snapchat account to demonstrate its effects on a patient who specifically asked for additional fullness in her upper breast pole.
Prior to surgery, Dr. Smiley performed breast and chest exam to determine the ideal implant profile, size, and shape based on the patient’s underlying anatomies. Of course, the surgeon also interviewed her to identify the aesthetic goals and to explain to her the surgical approach and implant design that could help meet her objectives.
During physical exam, Dr. Smiley used a pair of calipers to measure the breast width and identify any pre-existing asymmetry between the two breasts.
The celebrity plastic surgeon noted the patient’s highly symmetric breasts that had nice overall projections and ample soft tissue coverage, making it easier to achieve natural and balanced results from breast augmentation surgery.
“It is quite unusual to have highly symmetric breasts. For the vast majority of patients, one of the pre-existing breasts is bigger or wider than the other side,” he said in a Snapchat video.
Based on physical exam and consultation, Dr. Smiley decided to use 375 cc silicone high profile implants; these were the perfect choice as the relatively thin patient was more concerned about the upper pole fullness than the actual augmentation.
It should be noted that 375 cc implants would provide just a moderate amount of augmentation, leading to a more proportionate, natural result.
During surgery, Dr. Smiley positioned the silicone implants beneath the pec muscle, which provided additional soft tissue coverage, resulting in a softer feel and a more natural breast contour. This implant placement also reduced the risk of traction rippling and palpability.
Breast implant consultation varies from patient to patient, although it usually lasts between 30 minutes and two hours. Others require more than one preoperative visit before they are completely comfortable going under the knife and have all their questions/concerns answered.
Dr. Tarick Smiley, a renowned Los Angeles plastic surgeon who performs cosmetic and reconstructive breast surgeries, gives his tips on how to make the most of your preoperative consultation.
After doing your own research by watching and reading contents from reputable sources, Dr. Smiley says the next step is to jot down the questions that will help you assess your surgeon’s qualifications, the most ideal breast implant size and design, and all the ramifications that come with the surgery.
You should bring this list of questions during your preoperative consultation so you would not overlook issues that are important to you, says Dr. Smiley.
Aside from the list of questions, Dr. Smiley says you should also bring the following during your consultation:
- A list of your complete medical history. This should include your previous surgeries, medical conditions, and drug allergies.
- You may bring along your spouse, friend, or family member. They may ask questions on your behalf that you may have overlooked.
- A list of medications you take. Remember that this should include not just prescription drugs but also over-the-counter medications, herbal supplements, and vitamins and minerals.
- Bring your “wish pics.” While these could help you explain your cosmetic goals more clearly, remember that the final results will still largely depend on your underlying anatomy.
- You may bring different types of clothing. Todays’ surgeons typically offer breast implant sizers that are worn inside an unpadded bra, allowing their patients to visualize the most likely results of their surgery.
Take note that you should not feel rushed during your consultation. In fact, you may meet with your surgeon as many times as you want should you still have lingering concerns.
Trends in breast augmentation are greatly influenced by media, social and cultural-based beauty standards, and prevalent lifestyle. Nonetheless, all efforts are made to create results that will satisfy the patients on a long-term basis.
While some trends in breast augmentation come and go, there remain some well-entrenched guidelines that aim to promote patient safety. For instance, board-certified plastic surgeons only use FDA-approved breast implants whose manufacturers are mandated to participate in longitudinal studies to further determine the safety and long-term effects of their medical products.
Liposuction collects fats from multiple donor sites. Then, these are purified and injected into the breasts to prevent implant wrinkling and palpability and other surgical stigmata.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that a growing number of breast augmentation patients today are choosing a more conservative implant size, leading to a more natural proportion.
The conservative implant size range is also becoming popular as more women these days follow a healthy, active lifestyle. In the past, it was not uncommon for patients to ask for significant augmentation (i.e., bigger than D cup) even though the size would not match their physique.
Some patients are more concerned about the breast shape than the size, making them an ideal candidate for conservative-sized implants. A survey published in Evolution and Human Behaviour has suggested that while men’s preference in breast size greatly varies, almost everyone agrees that no matter what the size is, the aesthetically pleasing ones are always “perky.”
Hence, many breast augmentations today are performed concurrently with mastopexy (i.e., breast lift). The idea is to correct the droopy appearance and the insufficient “cup size” in one surgery.
And since there is a strong inclination to natural-looking results, many surgeons nowadays complement breast augmentation with fat grafting or injection. The idea is to create additional soft tissue padding to further conceal the implant edges, resulting in softer feel and more teardrop breast contour.
Nonetheless, fat grafting is rarely used as a primary method in breast augmentation, although many surgeons believe that it is a powerful supplemental tool in order to make the results more natural.
A simultaneous fat grafting is often warranted if the patients have very poor cleavage and little soft tissue coverage. Some women with pre-existing deformities (due to previous surgeries or congenital defects) can also benefit from this supplementary procedure.
Breast revision for capsular contracture requires meticulous procedures to prevent the complication from recurring. The core guideline is to eliminate the bacteria, which are believed to cause the body to react and release a thick biofilm or scar capsule that causes hardness and asymmetry of the breast.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated breast revision for capsular contracture on his Snapchat. The surgery involved a patient with silicone implants she had for eight years; these were implanted by a different doctor.
Dr. Smiley irrigates the implant pocket with strong antibiotic solutions to kill microorganism known to cause low-grade bacteria, which is linked to increased risk of capsular contracture.
The patient’s left breast appeared constricted and “high-riding” due to the thick fibrous scar tissue, while the right side had no such problem. Dr. Smiley said that about 98 percent of capsular contracture affects only one side due to unknown reasons.
Every time an implant—e.g., breast implant and pacemaker—is placed, the body makes a layer of tissue called capsule. Dr. Smiley said this is an auspicious natural process that prevents implant malposition.
He said that the only time that the capsule is considered capsular contracture is when it becomes too copious and “problematic,” leading to hardness of the breast, asymmetry and unnatural contour (narrow and constricted base), and a varying degree of pain and discomfort with arm motion.
The celebrity plastic surgeon cited medical literature suggesting that the risk of capsular contracture in primary breast augmentation is around 5 percent, and may reach as high as 33 percent in revision surgery.
Dr. Smiley said that irrigating the breast pocket with strong antibiotic solution reduces the capsular contracture rate by “killing the microorganism.” According to several studies, low-grade bacteria may cause the copious production of fibrous tissue, but not enough to cause an infection.
To further reduce the capsular contracture rate in primary and revision breast augmentation surgery, Dr. Smiley emphasized the importance of using brand new implants and removing the entire scar capsule, instead of just incising or eliminating some parts.
In addition, Dr. Smiley said that placing the implants beneath the muscle than above this layer (with only the breast tissue enveloping the prostheses) further minimizes the risk of capsular contracture. The theory is that the reduced contact between the implant surface and the tissue known to harbor staph bacteria, and the constant massage provided by the pec muscle preclude the formation of copious scar tissue.
Some patients require areola reduction and breast augmentation to achieve the most aesthetically pleasing results possible. It should be noted that large areolas make the breasts appear matronly even though these are not droopy.
Leading Orange County plastic surgeon Dr. Tarick Smiley has recently demonstrated on Snapchat the areola reduction and breast augmentation surgery performed in a patient who had “double bubble deformity” in which her breast tissue looked like it was hanging from the implant.
The patient requires areola reduction as part of her reconstructive-revision breast surgery.
To correct the double bubble deformity and allowed the new implants to settle into their most natural position, Dr. Smiley also performed a simultaneous breast lift.
The patient’s breast lift involved donut-shaped incisions to reduce the size of her areola. Supplementary incisions from the bottom of the areola and the inframammary fold that were extended across the base of the breast were also used to improve the overall shape and projection of the “breast mound.”
Dr. Smiley reduced the size of the areola by creating a circular incision around the desired diameter, which is about 38-42 mm, and another one at the dark-light skin junction. This donut-shaped incision pattern allowed him to shave off the skin (epidermis) in between, a technique medically referred to as de-epithelization.
Dr. Smiley said all efforts are made to reduce tension during the closure of areolar incisions to prevent healing problems and re-expansion or “spreading” of the areola, which may happen over time. Hence, he used several deep rows of sutures in which the tissue, not the skin, would receive most of the “tautness.”
Reducing tension on the skin would also allow the scar to fade nicely into the background, said the celebrity plastic surgeon.
Because the circumference of the outer incision was larger than the inner incision, the skin of the areola’s margin was “gathered” during the closure. This resulted in the pleated appearance of the new areola’s border, although within a few months this will flatten out.
To further achieve a nice breast shape and size, Dr. Smiley created “more distance” between the areola and the inframammary fold. In most cases, the ideal areola position is about 3 cm above the breast crease, he explained.
Meticulous breast exam and surgical planning is the key to achieve breast augmentation and lift results that look natural and proportionate, said leading Inland Empire plastic surgery expert Dr. Tarick Smiley on his recent Snapchat post.
Dr. Smiley has recently demonstrated this “combo surgery” performed on a patient who had these following aesthetic problems:
- Sagging breast tissue
- Deflated upper breast pole
- Disproportionately huge nipple that dropped below the level of the submammary fold
While the patient’s preexisting soft tissue was sufficient, a breast lift-alone approach would not give her the upper pole fullness she wanted; hence, the use of concurrent small implants was fitting to deliver her aesthetic goals.
The use of small implants would give her not just additional fullness of the upper pole, but would also improve the overall projection of her breasts, Dr. Smiley said.
To give her more cleavage and “overall fullness,” the celebrity plastic surgeon used moderate profile implants whose forward projection is predetermined by their width. They are perceived to be the standard design as the provide just the right amount of “roundedness” without causing excessive fullness in the upper breast pole; hence, they simulate the look of an attractive breast that occurs “naturally.”
In the context of breast lift, Dr. Smiley performed the standard technique in which the incisions were created around the new smaller areola. The incisions were then extended down the midline and across the base of the breast, leading to an inverted T scar.
To ensure lasting “perkiness,” the surgeon elevated the internal breast tissue with “special sutures” that would act as a sling. This “fine-tuning technique” also allowed the silicone implant to remain centrally behind the areola.
Furthermore, he created more distance between the smaller areola and the submammary fold (about 3 cm), further contributing to the perkier and more youthful appearance.
Dr. Smiley noted that “all efforts are made to eliminate tension” in order to promote the best scar possible. During the creation of areolar incisions, he made them into perfect circle so the tension could be equally distributed. In addition, the wound was sutured in several rows so the skin would not receive excessive “tautness.”
The use of smaller or conservative-sized breast implants also favored the patient because of the reduced tension. It should be noted that overlarge implants used concurrently with breast lift might create too much “opposing tension” on the skin, which could result in higher risk of unfavorable scars and poor healing.