Breast Augmentation Choices

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1 Information provided is intended to inform clients of options available and outcomes. However, not all patients, procedures,or surgeons are the same, and information may not be applicable to all patients The Surgeon may reserve the right to vary the way that a procedure is performed or which technique is used. Breast Augmentation Choices Decisions, decisions, decisions. Once you have decided to undergo Breast Augmentation with implants, you will have a host of other important decisions to make. This information sheet is designed to provide you with the facts on the available breast implant options not influence you one way or another, but to help you make the most informed decision possible about all of the variables involved in your surgery. Implant Size Choosing the right size for your new breast implants is important. The #1 reason that women go back for revision breast augmentation is because they wish they went bigger, but bigger isn't always better, especially if you have a tiny frame. Deciding to have breast augmentation is the easiest part of the process. Choosing the right size breast implant can take a little longer. The keyword here is YOU. Choose a size that makes YOU happy, not your spouse, significant other, family member or best friend. After all, you're the one who will be living with this decision. Implant fill Silicone, Saline and now Foam (Brazilian implants) is only one piece of the pie. Other choices include the implant surface (textured or smooth?), implant shape (round or contoured?) and implant profile or projection. Don t feel overwhelmed. we have gathered informative information on the different implant types to save you time on the reseach! Implant Surfaces, Profiles and Shapes Breast implants come in shells that are either smooth or textured. There are pros and cons to both smooth and textured breast implants. Breast implants are available in low, moderate and high profiles. The profile of an implant determines how far it protrudes from your chest wall. The two basic breast implant shapes are round and teardrop. Breasts differ greatly from woman to woman, so the ideal breast implant shape for each patient must be determined with care. Implant Placement Should your surgeon place your breast implants over, patially under or under the chest muscles? Get informed on the advantages and disadvantages of your implant placement options in the info sheet. Incision Choices There are three main options for breast implant incisions. Implants can be inserted through incisions around the nipple (periareolar incision), under the breast in the inframammary crease (inframammary incision),or in the armpit (transaxillary incision). The choice of incision pattern for your breast augmentation depends on your surgeon's preference or training, your anatomy, your goals and the type and size of your breast implants.

2 IMPLANT PROFILE High Profile High profile breast implants are a great innovation in breast implant design. First available in the early 1990 s, high profile implants have filled the specific needs of many patients perfectly, helping them to achieve a pleasing breast aesthetic and an extremely natural shape and contour. High profile implants have also become a favorite of many cosmetic surgeons and are recommended to many patients due to their excellent surgical results. High profile implants project the further off the chest wall, when compared to other common implant profiles. The high profile implant will achieve this projection by having a smaller base diameter than an identically sized (in cc s) moderate or low profile implant shell. By decreasing the diameter of the shell, but keeping the same fill volume, the manufacturer is able to increase the depth or forward projection. High profile implants are perfect for women with a narrower chest frame who still want a considerable size increase during their breast augmentation surgery. Instead of using a wider base diameter moderate implant, the doctor will choose a narrower high profile shell which will suit the patient s anatomy and project out to accommodate the volume of the filler material. High profile implants are also commonly indicated for patients who are undergoing a combination breast enlargement and donut mastopexy procedure. This modified mastopexy, like many breast lift operations sometimes squares off the breast shape slightly, making it appear wider and less round. The shape of the high profile implant shell restores the rounded shape of the breast, while still allowing the considerable benefits of the mastopexy lift. it is simply a better anatomical fit. Wrinkling and rippling often occurs when a women with a narrow chest frame desires large implants. The base diameter of her natural breasts is smaller than the base diameter of her implants. Obviously, the implant will be compressed and distorted by the small confines of the pocket inside her breast. This distortion causes the wrinkling and rippling which can be so unappealing to many affected patients. By utilizing a proper fitting high profile implant with a base diameter smaller than the natural breast width, the surgeon can guarantee a good fit with no implant shell distortion. The patient s size request is accommodated by the increase in forward projection creating a flawless augmented, but very natural looking breast. Ultra High Profile Ultra High Profil eimplants availabe through Mentor provides the narrowest base and highest projection. They are only available in Round shape and up to 495cc. Ultra High profile implants are perfect for women with a narrower chest frame who still want a considerable size increase during their breast augmentation surgery. Instead of using a wider base diameter implant, the doctor may choose the ultra high profile if the high profile is not enough projection. This may suit the patient s anatomy and project out to be able accommodate the volume of the filler material. There are two ways to increase projection in an implant. The first way is to add more volume to the 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. While some studies say that these high profile shells reduce visible wrinkling and rippling, the reasoning given is generally incorrect. It is not anything to do with the design of the implant which decreases this noticeable unwanted breast enlargement complication;

3 INCISION CHOICES When you choose to have breast implant surgery, you need to choose which incision or entry point you want the surgeon to use to place your implants. There are three options to choose from for your Breast Implant Surgery. Breast enhancement procedures are performed using one of the following three incisions: Periareolar Inframammary fold Transaxillary Transumbililical You should be able to get the same excellent results no matter which incision you choose. Please do not fret too much over this decision. You and your surgeon will be able to work together to determine what incision seems best for you. Inframammary Fold Commonly Referred to as "Under the Breast" This is the most popular approach and the one used the most often.this incision is placed at or near the lower breast fold. It offers the accessibility for control like the peri-areolar and can be used for re-operation if required. This might be the incision of choice in the case in which the woman would like to preserve potential breast-feeding as much as possible. The approach avoids most of the breast ducts preserving breast anatomy the best. Advantages Does not interfere with breast feeding Leaks are easily Scar is completely hidden naturally by the breast Doctor has extra control in the placement of the implant. Disadvantages Wearing a bra can cause irritation to the scar. May not be the best option for flat chested women that don't have extra tissue to create that hidden crease. Not very suitable for dark skinned people With crease breast implant incisions, the resulting scars should be visible only when you are in a horizontal position. The surgeon usually tries to situate the breast augmentation incision so that it will fall just above the inframammary fold to prevent the scar from being seen. The surgeon must properly evaluate where the incision will be in relation to your new breast size. If the incision is made too high or too low, the scars could be very noticeable. Transaxillary Commonly Referred to as "Through the Armpit" Transaxillary, or underarm, breast implant incisions utilize one of the breast implants incision sites that involve no cutting of the breasts. Instead, the breast augmentation transaxillary incision allows breast implants to be inserted through the armpit This incision was designed in an attempt to move the incision off the breast into a fold in the armpit. In most cases, breast implant incisions in the armpit area tend to cause less future breast feeding complications than some other breast implants incision sites. If the patient requires re-operation, it is rare for it to be possible via the "armpit" incision, so usually another incision is made. The implant can be placed pre-pectoral "over the muscle" or retro-pectoral "behind the muscle" via this approach. The incision site for the transaxillary breast augmentation technique is the armpit. Once the armpit breast augmentation incision has been made, a channel is made to the breast. Through this channel, the breast implant is inserted and then worked into place..

4 INCISION CHOICES Transaxillary Advantages The scar remains hidden under the arm Less interference with a bra during the healing process. Scar is virtually invisible in the armpit fold Disadvantages More Post-Op pain experienced If there is a problem in the future, an addition cut may required. Higher incidence of implant being positioned higher. The biggest advantage of an underarm breast augmentation incision is the fact that transaxillary breast implant incisions leave scarless breasts after the procedure. Since the armpits normally remain concealed, scars resulting from transaxillary breast implant incisions are highly inconspicuous, even if they do not heal properly. Periareolar Commonly Referred to as Through the Nipple Along with inframammary breast implant incisions, the areola incision (sometimes referred to as the Periareolar technique) is currently one of the most widely used methods for placing breast implants. In this technique, an incision is made at the edge of the areola the pigmented area of skin that surrounds the nipple. The incision is made on the edge, where the lighter breast tissue meets the darker tissue, so that the scar will blend in. Protective "sleeves" are utilised when inserting the breast implants through nipple incision sites in order to protect the breast ducts. Similar to the crease incision, an areola incision allows the surgeon to work close to the breast, allowing for easier placement of breast implants. Using the areola or crease breast implants incision sites makes it possible for the surgeon to place the breast implants in various positions in reference to the chest muscle. The implant can be placed pre-pectoral "over the muscle" or retro-pectoral "behind the muscle" via this approach. Patients who wish to undergo mastopexy, or breast lift, in conjunction with breast implants will likely receive the areola breast augmentation incision, since both of these procedures can be performed with this type of incision. Advantages Control in making sure the nipples are placed evenly. The Scar fades to a colour close to the areola for minimal visibility. A good choice for people undergoing a breast lift also. Disadvantages There is a small risk of losing sensation in the nipple. Chance of nerve damage Slight chance of difficulty breast feeding One of the biggest advantages of the areola incision is that the surgeon is able to work closest to the breast, thus in many ways making it less invasive. Endoscopic While the endoscope has been used primarily for brow lifting, mid face lifting and also tummy tuck surgery procedures, it has now also found a place in breast enhancement surgery Breast Augmentation yields smaller incisions that are more discreetly placed. Smaller incisions mean less noticeable (if noticeable at all) scars, less trauma to the body, and faster healing time. Advantages Scars are hidden away from the breasts Recovery is shorter and more comfortable The risk of many post-surgical complications are reduced Disadvantages Not Suitable to patient having Breast Lift Revison surgery may not allow for Endoscope During an endoscopic breast augmentation, the plastic surgeon is able to work easier in positioning breast implants within the patient's chest wall. Utilizing the same basic techniques incorporated in a regular breast augmentation, the patient benefits from an endoscopic breast augmentation by having fewer scars. This is because endoscopic surgeries tend to leave much smaller scars that are more likely to be hidden. This is because only a few small incisions are required to insert the endoscope probe into the patient. These incisions are less than one inch long and the small size of these incisions helps to minimize some of the after effects of the surgery. Additionally, in some cases of endoscopic surgeries, the patient's recovery time was much shorter in treatments that were performed as open procedures.

5 IMPLANT PLACEMENT Like every other decision about breast implant surgery, the question of whether to place the implant under the muscle,partial or or over is the subject of much debate, with confusion and misinformation in every direction. Suffice it to say that there is no single best method that applies to every patient. Breast Anatomy The pectoralis major muscles makes up most of the layer of muscle beneath the breast tissue. Since it is only attached to the chest wall around the edge, there is a potential space beneath it where an implant can be placed. The pectoralis minor muscles attach to the shoulder blade (scapula) and stretch down to the ribs. How The Surgeon Determines Placement Final determination of what implant position is best for each patient must follow a complete evaluation of several factors: * The patient s individual anatomy, inc: thickness of tissues and the degree of sway in breast. * The patient s desire regarding volume increase Breast Implant Placement Terms Placement of breast implants is performed in three methods: * The patient s lifestyle, inc: the exercise routine * The patient s personal history of breast disease Only by taking all factors into consideration can an appropriate decision onplavement be made. You should only be guided by the surgeon; the patient cannot determine what is best. However, your decision may be influenced by these issues which you can discuss during a consultation. Subgrandular Placment: Breast implants placed under your natural breast tissue, which is called either subglandular (located under the breast gland) or over the muscle placement Submuscular Placement: Breast implants placed under the pectoral muscles, called submuscular or under the muscle. Subglandular Breast Implant Placement When the implant is placed in front of (above) the muscle, that is usually called subglandular, since the breast is a gland. There is an increased chance of your (or someone else) being able to feel or see the implant. Pros Implants are very easy to place. Move naturally Avoidance of a breast lift, or mastopexy, due to mild sag (ptosis), however, this is usually a "quick fix", and a lift will, many times, be needed in the future. Less recovery time, with less post-op discomfort/pain, since the muscles are left in tact, and only skin and fat are cut. Larger implants may be placed, Cleavage is more easily created with overs, particularly if the breasts are naturally spaced wide apart. Cons Ripples are more easily seen and felt, especially in women starting with little or no breast tissue. Capsule contracture rates are highest in women with implants placed over the muscle. Bottoming out is a larger risk with overs and partial unders than with implants placed in the complete submuscular position. Many women who lift weights opt for over the muscle placement. This is mostly due to the fact that when the pectoral muscles are flexed, the implant does not become distorted in shape. Overs can give a more "fake", augmented look. There tends to be more of a pronounced "roundness" to the breasts, versus the look that unders give, which is a more natural slope. Again, this is not the case for ALL sub-glandular implants, but does seem to be truer for those who have little to no breast tissue to start with. There is nothing at all wrong with this look. It's simply a matter of personal preference. Partial Subpectoral- The top 2/3 of the breast implant is covered by the pectoralis muscle.

6 INCISION CHOICES Submuscular Breast Implant Placement When placed completely beneath the muscle they re NOT totally behind the pectoral muscles. The top 2/3 of the implant is behind the pectoral muscles and serratus muscles, and the lower 1/3 is behind the fascia, Having the implants completely beneath the pectoral muscles ALONE is not anatomically possible. Pros More natural contour to the upper breast The implant is fully covered, by the muscle and fascia, which helps to camouflage the edges of the implant, as well as ripples in the implant. While visible rippling is possible with all three placements, having complete submuscular placement has the least risk of visible rippling. The fascia serves as support to the lower pole, whereas with partial sub-muscular placement, the skin tissues support the weight of the implant. Complete unders serve as sort of an "internal bra". Lower risk of bottoming out Cons More post-op discomfort. Longer recovery. Less lift for the pendulous breast. Minor distortions in breast shape when muscular contraction occurs. # Greater patient awareness of the implant during exercise Breasts may sit a bit higher at first until the muscle relaxes (same is true with partial submuscular placement.) Implant distortion when the pectoral muscle is slightly flexed, which is also true with partial submuscular placement. If you have little breast tissue pre-surgery this placement is definitely recommended as there is less chance you will feel and see rippling of the implant with saline implants. If you have Ptosis (sag) of your breasts pre-surgery this placement may have to be performed with a lift to avoid the implant sitting high and the skin lower. Partial Subpectoral Implant Placement The term total Partial submuscular is used when other muscles on the chest wall are raised in order to cover the sections of the implant that the pectoral muscle doesn t. Specifically these areas are on the outside (lateral) and the lower portion. Pros Decreased risk of visible and palpable ripples and implant edges, except for the lower 1/3 portion of the implant, which is not covered by the muscle/fascia Most of the time, a more natural shape to the upper portion of the breast is achieved. In general, there is a more natural slope to the breast, instead of the "upper roundness" that is can be more common with over the muscle implants. This is a good thing, if this is the look you desire. Cons More post-op discomfort, and longer recovery period. This is due to the procedure being more invasive, as well as the muscles stretching out to accommodate the implant. The implants take longer to "drop" or "settle" into the pocket. The breast implant may appear to be distorted while flexing the chest muscles. The implants are supported by the same tissues (skin) as over the muscle implants, which means less lower pole support (compared to implants placed completely behind the muscle/fascia), which can possibly lead to bottoming out, although bottoming out is possible with any placement. Ripples (wrinkling of the breast implant shell) may been seen and/or felt along the lower and outer 1/3 of the implant (the part which is only covered by the breast tissue). However, ripples are possible with the implants placed completely under the muscle, as well. The extremely thin patient will usually achieve superior results through partial submuscular implant positioning. This is particularly true for larger volume augmentations.

7 Implants come in a variety of shapes, sizes, textures. There are silicone, saline, polyurethane, smooth breast implants, textured breast implants, round breast implants, anatomical breast implants. There are also various "profiles", such as moderate profile, high profile, and low profile breast implants. You will want to familiarise yourself with the options available so that you can get an idea of what type of implant you want. You should know the advantages and disadvantages to all of the breast implants currently available. This knowledge will allow you to ask more educated questions at your consult, as well as help you to decide which particular breast implant is right for you. The Hospital that we use in Thailand use either Mentor or Silimed implants that are used world wide. The lifespan of breast implants depends on the individual. In some cases they will need to be replaced within the first couple of years after surgery; others can last as long as 25 years. In general, the manufacturers of breast implants say the products should last, on average, about 10 years. Saline Implants Saline implants were the most frequently used implants prior to the introduction of Silcone Gel and most recently polyurethane. They vary in shell surface (i.e. smooth or textured), volume, shell thickness, profile, shape (round or anatomical), as well as expandable implants. Most saline implants are single lumen, and are filled at the time of surgery. The shell consists of a strong, silicone elastomer shell, and is filled with a sterile saline solution at the time of surgery. Should these implants rupture, the body will absorb the saline, much like drinking a glass of water. Saline breast implant sizes range from 120cc to 850cc, and they are available in round and teardrop shapes so that a procedure can be tailored to a patient's specific body contour, saline breast implants are filled during surgery. IMPLANT TYPES Implant Types Advantages Peace of mind for those who are unsure of silicone gel Leaks are easily detactable Increased projection when desired Disadvantages Higher risk of rippling More easily palpable (feels less natural in most cases) Increased projection when not desired Silicone Gel Implants Currently the most popular choice for augmentation procedures. Silicone implants offer more natural looking and feeling results than other types of breast implants because silicone gel is more similar in consistency to breast tissue. Silicone gel breast implants come pre-filled, meaning that there is no fill to be added. The only real drawback to a pre-filled implant is that the incision will have to be a bit longer, depending on the size of the implant to be inserted. This is especially true for textured silicone and gummy bear silicone implants, which are somewhat firmer. Another reason that textured silicone implants require a longer incision is the fact that the shell is textured. Modern silicone implants are a marvel of technology and aesthetics. There are choices of size, profile, shape and texture which give patients a custom design suited to their specific needs. The outermost part of the implant is called the shell. This shell is bonded to the filler material so that the filler will not bulge or leak. In earlier versions of silicone breast implants, the filler material was separate from the shell and might leak through if the shell was compromised. The unified shell and filler design creates a safer prosthesis, which will not fold or wrinkle, producing a more natural appearing breast.

8 IMPLANT SHAPES Until recently, most patients never discussed breast implant shapes or profiles with their plastic surgeons. If you chose a certain size breast implant, you would receive a predetermined amount of forward projection from that size implant. Now, you can choose a breast implant size and, if you like, have that size implant stick out more or less than the base diameter would usually dictate. Choosing breast implant shape may seem complicated since manufacturers have so many styles in their lineups. However, it s really only a matter of making two choices. The first choice is the breast implant shape; the second choice is the implant profile. Shape refers to the actual shape of the implant, round or anatomical. Profile refers to the distance the implant projects off the chest wall. The third Choice is the the surface of the implant. Shapes Round Anatomical (Teardrop/Contoured/Shaped) Profiles Low Moderate Moderate Plus High Ultra High Surface Smooth Textured Shapes Because women's breasts take many sizes and shapes, and because goals for breast enhancement vary from patient to patient, there are different breast implant shapes available. For some women, the round breast implant provides the best results; for others, a better choice is an implant shaped like a teardrop. The appearance of breasts is highly affected by breast implant shapes. Round Implants Of the two breast implant shapes, the round breast implant is the most common type used for breast augmentation. A round breast implant is shaped like a flattened sphere. Certain types of round implants can enhance the forward projection of the breasts, which would otherwise require larger breast implants with wider bases. For women who desire fullness in the upper poles of their breasts, the round breast implant is a good choice. Many women choose round implants because they tend to provide the greatest amount of lift, fullness, and cleavage. Some women, however, feel that the results produced with round implants appear artificial, so they seek out more natural-looking alternatives. A round breast implant can have a smooth or textured surface. Due to a round implant's symmetrical shape, it does not pose the risk of implant rotation. The cost of a round breast implant is generally less than a teardrop (contoured) breast implant. Tear Drop Implants As the name indicates, a teardrop breast implant, also known as a contoured breast implant, is shaped like a teardrop. Breasts attain a more gently sloping contour with teardrop breast implants. Although the upper poles of breasts that have teardrop implants are not as full as those of breasts that have round implants, teardrop-shaped implants often provide greater projection by volume. Of the two breast implant shapes, a teardrop breast implant is more expensive than a round breast implant, a consideration for those concerned with breast augmentation cost. A teardrop implant requires a textured surface to prevent rotation because, with teardrop implants, breasts can become distorted if the implant rotates. This is not a concern with round breast implants. Considerations include: The patient s body type The amount of breast tissue the patient has. Breast implant placement Surgical incision choice

9 IMPLANT SURFACE Surfaces After you have made the choice to have breast implant surgery, you must decide between two breast implant texture options: smooth and textured. On this page, we describe the differences between the two types to provide you with a better understanding so you can make an informed decision. There is great debate amongst surgeons which is better. Some studies have shown fewer complications specifically capsular contraction with textured implants, but others have shown the opposite. The shells of both saline and silicone gel breast implants are made of silicone elastomer (rubber), and the surface area is either smooth or textured. The main purpose of textured implants is to promote tissue adherence to the irregular surface and hold them into place. Therefore, a textured surface is used with contoured implants because they have a top and bottom, and rotation or movement distorts the breast shape. On the other hand, most round implants have a smooth surface because the breast shape is not affected if the implant rotates in the breast pocket. Smooth Implants Smooth implants are used in roughly 90 percent of breast augmentation surgeries today. A smooth breast implant is able to move freely in the breast pocket in which it is placed. Many women feel that smooth implants have a more natural feel and appearance than textured implants. Smooth implants usually have thinner shells than textured implants, which makes them the softer choice of the two. Additional benefits of a smooth breast implant include implant longevity, lower patient cost, and reduced risk of rippling. Textured Implants It was originally thought that the textured surface of an implant could reduce the possibility of capsular contracture, a potential complication of breast implants. However, because evidence is not clear and there is no consensus as to whether a textured breast implant actually reduces the possibility of capsular contracture, many doctors prefer to use smooth, round implants. Smooth implants are often placed under muscle tissue in order to help avoid possible capsular contracture. Textured breast implants have an irregular surface that is intended to hold the implant in place. The scar tissue that naturally forms around the implant conforms to the textured surface and "grabs" the implant to prevent it from being displaced or turning in the pocket, which could result in distortion of the breast shape. A textured surface is used with contoured implants to prevent movement because the teardrop shape is distorted if any rotation occurs. Textured implants were designed to lessen the risk of capsular contracture, which is an excessive contraction of the scar capsule that surrounds the implant, by preventing scar tissue from forming around the implant in a uniform manner. However, studies have proven inconclusive and no firm evidence exists to support the theory that textured implants reduce the risk of capsular contracture. If a patient requires implant removal due to capsular contracture or another complication, it may be more difficult for the surgeon to remove the implant because of the adherence of tissue to the textured surface. The shells of textured breast implants are slightly thicker than smooth implants. Textured implants are more firm and carry an increased risk of rippling that is visible or can be felt through the skin, especially for women with smaller breasts. There is also a small increase in the chance that the implant shell will rupture.

10 IMPLANT PROFILE When breast augmentation patients meet with plastic surgeons to discuss the many implant options that are available to them, they not only need to decide on a specific sized implant, but determine the amount of forward projection that is appropriate for the patient as well. In the past, implants came with a standard projection, or profile, based on the size of the implant that women choose. Today, surgeons and patients can work together to select an implant that is not only the right size, but also provides the desired projection and cleavage.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. Breast implants come in Low, Moderate, Moderate Plus, High and Ultra High Profile - each offering a different level of projection (profile) for each woman's preference and body type. Low Profile Moderate Profile Moderate profile breast implants are still the most popular of all implant profiles. Moderate profile implants offer a nice balance between shell diameter and depth, which works well for the majority of women seeking breast enlargement surgery. Moderate profile is defined as typical in proportion from diameter to projection, where as moderate plus is slightly less wide and slightly deeper, projecting more from the chest wall. Not every implant style is available in the moderate plus profile. These versatile implants are sometimes also called medium profile breast implants. Cosmetic surgeons use moderate profile implants in the majority of their augmentation surgeries, although the high profile breast implant is steadily becoming more popular. The moderate profile implant is a good general choice for most women with typical breast augmentation needs. Moderate implants come in more sizes than any other profile. Some sizes are available in the moderate plus profile, which can achieve a custom fit in women who fall in the middle of the fit criteria between moderate and high profile. Moderate Plus Profile The low profile implant shell is wider (larger diameter) and flatter (less height or depth) than moderate profile breast implants. This implant style is commonly used for women who have a wide broad chest frame. The extra width of the implant shell will fill the chest anatomy correctly, achieving a natural look and realistic cleavage. The implant will not project as far off the body as other implant styles, making it the right choice for women who want fullness, but not an overly round and obviously enhanced look. The main criteria used to select low profile implants are the base diameter of the breast and dimensions of the chest. The implant should be smaller than the base diameter of the natural breast mound, which is often substantial in wider framed women. Moderate plus implants are a half step compromise between traditional moderate profile implants and popular new high profile implants. The moderate plus profile is perfect for women who want a bit more projection than is typically provided by a moderate profile, but not as much projection as is found with the high profile shell. Moderate plus describes the distance the implant will project off the chest wall, once they are surgically placed inside the breast.