Ask Dr. Pane: How to Choose the Right Breast Implant for You

Breast augmentation surgeries remain a perennial chart topper in the cosmetic surgery world’s body procedure pantheon, routinely appearing in the most frequently done cosmetic procedure roster in first to third place year after year. Choosing the right breast implant size, type and method can mean the difference between the beautiful figure you’ve always dreamed of and a breast aesthetic you don’t love. Dr. Pane chose to address this topic in a recent Instagram Live broadcast because it is such an integral and commonplace procedure and probably one of the top ten most frequently asked questions we receive at Atlantic Coast Aesthetics! As a board certified plastic surgeon and member of the American Society of Plastic Surgeons, Dr. Pane is well aware of the various arguments for and against certain types of implants, and felt a deep dive into this topic would help to dissipate some of the rumors and misinformation about them.

How do I choose a breast implant?

The most popular types of breast augmentation on the market today are fat transfer, silicone breast implants, silicone gel implants and saline breast implants. They are available in shaped implants or just regular round implants, with smooth or textured shells, each of which has different applications for adhering to the chest wall and the overall feel of the overlying breast tissues, and each of which has different uses and potential complications. Dr. Pane notes he does not typically use textured implants specifically because they do have a higher incidence of complications, but as with so many other things, this is taken on a case by case basis. For patients who aren’t good candidates for fat harvesting and fat graft procedures, breast implants can offer a lifelike, natural look and feel with very high satisfaction rates and a very low risk of complications.

Dr. Pane started illustrating different types of breast implants by showing a Mentor 450 HPX round breast implant. This implant is called that because it has a very pronounced top curvature and a flat bottom, also known as “high profile,” has an implant volume of 450cc and is filled with a proprietary “MemoryGel” which feels more like actual breast tissue. A low profile implant tends to be flatter on both sides, and a medium profile still has the convex curvature on top but it is not quite as apparent as in a high profile implant.

Dr. Pane points out the key factors which determine the size and profile of the right implant size and implant type for you include:

• Whether you have implants already
• How big your breast is to begin with
• How big you want your bust to be
• How thick the breast tissues are
• The breast width
• How sturdy the chest wall is and how much weight/force it can tolerate

Dr. Pane noted in the books in his library, which were visible during the broadcast and which he joked made him look smarter, is a seminal volume by a now-deceased cosmetic surgeon which evaluates in minute detail how to choose breast implant sizes for a given existing body style and desired outcome. “You can’t just put anything in anyone,” Dr. Pane says, “or your risk of having problems starts going way up.”

Which type of breast implant is best for me?

Dr. Pane doesn’t use 3D computer simulation during breast augmentation consultation when assisting patients in choosing the right breast implant. He has been to places which do use this technology and while it’s not bad for visualization purposes, that technology is at an early stage which only gives a visual rendering of what the patient can expect, without taking into account factors which may militate for or against a specific size or type of implant. Dr. Pane points out that although he doesn’t rely on 3D simulation, ACA achieves a rate of secondary and revision patients which is far below what the published literature establishes as a “normal” baseline, largely because Dr. Pane has experience with a lot of different techniques and working with, and learning from, a number of different surgeons to find what works reliably and what doesn’t as a cosmetic surgeon.

Dr. Pane says the primary considerations for breast implant sizing are the existing breast base, the thickness of the tissues and the final breast size the patient wants to achieve. “If people are interested in going as big as they can go, and they don’t care if it has a natural look, then we’re starting to get into the area of ‘how big can we get away with?’” Dr. Pane observed. Also, the overall goal of the implant needs to be taken into account when evaluating breast implant sizing. A mother who is done with childrearing and has lost volume in the breast area, who simply wants to regain bra cup sizes, is going to have different goals than someone who wants a breast lift (mastopexy) to go up a bra size or two, or breast implant revisions, which may actually require larger breast implant volumes, or mastectomy patients who are aiming more for breast reconstruction than a larger sized breast.

Which type of implant feels the most natural?

If you want the most natural feeling, you need natural material. This is why fat transfer and grafting has become so popular. When it comes to implants, everyone has a slightly different opinion about what a “good” implant feels like. The implant Dr. Pane showed at the beginning of the segment has demonstrated excellent touch test results, but no one responds to stimulus exactly the same way, so what feels natural to one person may not feel natural to another. So-called “gummy bear” implants tend to perform well in touch tests, but some people actually prefer regular saline or silicone implants. This is a very subjective area and again must be taken on a case by case basis.  

What is the most common size breast implant?

It’s typical to see breast implants in the 300-400cc range. When it comes to breast implants, “go big or go home” is not necessarily the case. Dr. Pane says he’ll see patients who have friends of a similar build and size with an outsized bust, and they want to equal or better it. The question here becomes, did the friend have ONE operation to achieve that size or multiple? The tissues will be more responsive to expansion when changing out implants, but again, there is an upper limit to the structural elements of the chest wall and the breast tissue which simply cannot be exceeded. One area where this may not necessarily be the case is with regards to transgender breast augmentation. This offers a wider breast base to start, but you have to ensure the tissue is thick and robust enough to support the implant. Transgender patients should be on hormone therapy for at least a year before considering implants, to help develop sturdier and more resilient breast tissue.

When you meet Dr. Pane for your initial consultation, he will evaluate your breasts to help determine the types of breasts which might best meet your needs. He and you may experiment with an implant sizer which actually fits in your bra, to give you a visual indication of what you’ll look like with the sized breast implants you’re considering. He will go over the recovery breast augmentation usually follows and give you general preoperative and postoperative care directions. Out-of-town patients and patients who are concerned about COVID-19 or other health risks may be offered virtual consultation, but an in-person clinical evaluation will still be necessary because video gallery conferencing can sometimes obscure issues which would be immediately evident in person.

Dr. Thomas A. Pane is a boardcertified plastic surgeon and the Chief Medical Officer and founder of Atlantic Coast Aesthetics. He and our friendly, professional staff offer services including but not limited to:

• body contour
• body procedures
• brow lift
• chemical peels
• ear surgery
• eyelid lift
• facial procedures
• inverted nipples
• neck lift
• skin rejuvenation
• spider vein
• vaginal rejuvenation
• and more!

If you have a question about any aspect of cosmetic surgery, Dr. Pane and the staff of Atlantic Coast Aesthetics are pleased to talk shop with our patients. Simply follow us on Facebook, Instagram, LinkedIn and Twitter; call us at (561) 513-4763; or email us through our Contact page. Your question could even be selected for the focus of an upcoming Ask Dr. Pane segment, helping us inform and educate others with your interests, concerns and questions while giving you the factual information you need to make informed choices and properly advocate for your cosmetic surgery journey. Remember, at ACA we believe the only bad question is the one you DON’T ask!