Choosing Breast Implants: Volume, Profile, and Placement

The first step in implant selection is a breast examination and measurements. The width of the breast base, the distance from the nipple to the notch at the top of the breastbone and to the inframammary fold, any asymmetry between the two breasts, and skin elasticity (how far the skin can be stretched) are recorded. These measurements set the upper limit for the base diameter of the implant that can be chosen: the implant's base diameter should not exceed the width of the breast base; otherwise the implant spills toward the armpit or the midline and creates an unnatural appearance.

The thickness of the existing breast tissue also matters. In patients with thin tissue, the edges of the implant are more easily felt and seen, which affects both the placement plan and the type of implant. Choices based solely on a desired size, without measurements, are the ones that most often require correction in the long run.

During the measurements, posture, spinal curvature, and the shape of the chest wall are also noted; differences in the rib structure can make the two breasts look different and influence implant selection.

Implant volume is expressed in milliliters (cc); it has no one-to-one equivalent in bra sizes. An implant of the same volume creates a noticeable change in a slim patient with a narrow chest, while it makes far less difference in a patient with a broad chest. This is why the question 'how many cc' cannot be answered without knowing your chest width and existing tissue.

At the consultation, different volumes are usually tried inside a bra using sizers or three-dimensional simulation. This step makes your expectations concrete; however, the final volume is chosen within the range that matches the surgeon's measurements. An implant larger than the tissue can support may lead over time to sagging, skin thinning, and visible implant edges.

Profile describes the relationship between an implant's base diameter and its forward projection. A low-profile implant has a wide base and is flatter; a high-profile implant fits the same volume onto a narrower base and projects further forward, with moderate-profile options in between. For a patient with a narrow chest who wants noticeable volume, a high profile may be appropriate, while a lower profile may suit a broad-chested patient who needs the base filled. The goal is for the implant to fill the breast base naturally, with no gaps or overhang at the edges.

Round implants give fullness in the upper pole and are symmetrical; if the implant rotates on its axis, the shape does not change. Anatomical (teardrop) implants have a fuller lower portion and a more sloped upper portion, closer to the natural breast silhouette; however, if they rotate in place they can distort the shape, which is why they are usually made with a textured surface.

Round implants are a frequent choice for patients with adequate breast tissue who want upper-pole fullness. Anatomical implants may be considered for patients with very thin tissue, mild sagging, or a clear preference for a natural slope. Which one is appropriate is decided by weighing the examination findings together with your expectations.

The most widely used implants today are filled with cohesive silicone gel; the gel structure limits the spread of the contents even if the shell is damaged. Saline-filled implants are less commonly chosen. The surface can be smooth or textured; textured surfaces are used on anatomical implants to reduce rotation.

Certain textured surface types are known to be associated with a rare type of lymphoma (BIA-ALCL). This risk is very low, but it should be discussed openly at the consultation, and the patient should be told which surface type was chosen and why. Brand and model are selected according to the surgeon's experience and the patient's anatomy.

The implant is placed under the chest muscle (pectoral muscle), over it, or with the dual plane technique, which combines the two. In submuscular placement, the upper part of the implant is covered by muscle; this reduces edge visibility and rippling in patients with thin tissue, lowers the risk of capsular contracture, and makes mammogram evaluation easier. The disadvantages are movement of the implant when the muscle contracts (animation deformity) and more pain in the first days.

Subglandular placement is considered for patients with enough breast tissue and those who use the chest muscles intensively; recovery is more comfortable, but in patients with thin tissue the implant edges can become visible. Dual plane covers the upper part of the implant with muscle while leaving the lower part under the breast tissue; in patients with mild sagging, it allows the breast tissue to reshape together with the implant. For most patients, the preferred approach is dual plane or submuscular.

The most commonly used incision is in the inframammary fold; the implant is placed under direct vision, the breast tissue is not entered, and the scar stays hidden in the fold. The periareolar incision is concealed at the border between darker and lighter skin, but because it passes through the milk ducts, it is evaluated more carefully with regard to breastfeeding and nipple sensation. The armpit incision leaves no scar on the breast, but control is more limited, and if a revision is needed later, the inframammary incision is usually used.

The choice of incision also relates to the type of implant: for anatomical and high-volume implants, the inframammary fold incision provides a more suitable entry. The scar is pink and noticeable in the first months; in most patients it fades within a year. Scar quality is affected by skin type, sun protection, and keeping tension off the suture line.

Most women have some degree of difference in volume or nipple level between the two breasts. In marked asymmetry, implants of different volumes can be placed on each side, or a small additional procedure can be added on one side; the goal is not perfect symmetry but reducing the difference to a level that is not noticeable.

If the nipple has dropped below the inframammary fold, an implant alone does not correct the sagging; adding volume can make it more visible. In that case, augmentation is planned together with a breast lift (mastopexy), either in the same session or in two stages. In mild sagging, dual plane placement is often enough; the decision is made at the examination by measuring the nipple position and the excess skin.

Implants are not devices that must be replaced on a fixed schedule, but they do require lifelong follow-up. Capsular contracture (hardening of the membrane around the implant), rupture, displacement, or rippling can develop over the years. The condition of the implant is monitored with an annual examination and, when needed, ultrasound or magnetic resonance imaging.

Pregnancy, breastfeeding, significant weight changes, and aging alter the breast tissue; even if the implant stays the same, the appearance can change, and years later a lift or implant exchange may come up. These possibilities should be discussed before surgery, and the type and volume of the implant chosen should be given to you in writing; every future evaluation will rely on this information.