Making Sense of Implant "Profile" in Breast Augmentation.

The increasing variety of breast implants has led to their classification into "profile" types to guide implant cataloguing and selection. Implant "profile" describes the overall silhouette of the implant. It represents a permutation of all 3 dimensions of the implant: base diameter, projection, and volume. Implant "profile" is not the same as implant projection. Implant projection is a quantifiable linear measurement of the anterior-posterior dimension of the implant, whereas implant "profile" is a vendor-driven assessment that currently lacks universal standardization. Until "profile" assessments are standardized across vendors, it behooves us to be cognizant of their limitations as primary variables used to guide implant selection.

INTRODUCTION

The increasing variety of breast implants in the market has complicated the process of implant selection for patients undergoing breast augmentation. Apart from the choice of silicone versus saline, textured versus smooth, and anatomic versus round implants, there remain 3 basic implant dimensions to be considered: base diameter (BD), volume, and projection.

To facilitate cataloguing of the many permutations of these implant dimensions, vendors have categorized implants into groups based on “profile.” Implant “profile” describes the overall contour or silhouette of the implant, with high profile indicating a high and relatively narrow implant, and low profile indicating a low and wide implant. “Profile” type has become prevalent in implant description and is often one of the primarily referenced descriptors when selecting an implant (i.e., a “200 cc, moderate-plus profile implant”).

IMPLANT “PROFILE” VERSUS PROJECTION

The confusion between implant “profile” and projection arises from the occasional misuse of the 2 terms interchangeably. Commonly, implant “profile” is inadvertently referred to as its “projection” (i.e., calling a “high profile” implant a “high projection” implant). Implant projection is the linear measurement of the anterior–posterior dimension of an implant. It is a single, numerical dimension, whereas “profile” is a 3-dimensional descriptor of implant projection (and hence, volume) relative to its BD. In essence, “profile” encompasses a permutation of all 3 implant dimensions, whereas projection represents only a single dimension.

“Profile” and projection do not directly translate. A high profile implant does not necessarily have a high absolute projection distance but rather a high projection distance relative to its BD. Likewise, an implant with projection distance of 4 cm may be categorized as low, moderate, or high profile, depending on its associated BD, volume, and manufacturer.

INCONSISTENT “PROFILE” CLASSIFICATIONS

In this day and age where multiple manufacturers pervade the market and have independent control over their implant classifications, what holds true for a high profile implant from a certain vendor may not hold true for a similarly classified implant from another. Adding to the confusion is the variety of descriptors that have been added to the traditional profile types, such as low-plus, moderate-classic, moderate-plus, moderate-high, midrange, full, extra-full, and ultra-high profiles.

Table 1 compares “profile” classifications across 3 major implant vendors.[1-4] Implants with similar dimensions are placed along the same row. For example, Natrelle INSPIRA full profile implants have similar dimensions to the Mentor MemoryGel high profile implants, which have similar dimensions to the Sientra moderate-high projection implants. Note that despite being dimensionally similar, these implants have been designated different “profile” names by their respective vendors. Vice versa, implants with the same “profile” classification do not necessarily represent similar dimensions. For example, the Mentor MemoryGel moderate-classic profile implant is more similar in dimensions to the Natrelle INSPIRA low-plus profile implant than it is to the Natrelle INSPIRA moderate profile implant.

Table 1.

Comparison of Implant “Profile” Classifications Across Vendors

CLINICAL PITFALLS

Clinical guidelines based purely on “profile” type tend to be rigid and overgeneralized, especially when individual implant characteristics are overlooked. For instance, universal caution against the use of all high or extra-high profile implants in breast augmentation[5] should be revisited to determine the precise implant dimensions actually implicated in disrupting soft-tissue equilibrium. There is no question that undue pressure on breast tissue should be safeguarded against when selecting an implant to avoid irreversible parenchymal atrophy and skin stretch. However, it is not just excessive projection but also disproportionate BD and volume that are potentially responsible for the negative soft-tissue effects. Determining which one of these 3 dimensions is most culpable is a whole other topic of controversy.[5-8]

Although it is undeniable that the “profile” assessments meticulously generated by implant manufacturers have become indispensable in guiding implant selection in a milieu of increasingly prolific options, their lack of standardization across manufacturers may lead to some clinical pitfalls. Although certain clinical guidelines are valuable within the confines of the specific manufacturer for which the recommendations are made, they may not translate to implant models from other vendors or outdated models.

For instance, guidelines recommending the use of all low or moderate profile implants for patients with “tight skin” and “filled breasts,” and all high profile implants for patients with “loose skin” and “underfilled breasts”[9-13] are oversimplified and should be revisited before their clinical application. The plastic surgeon must ask the discerning questions: Are these guidelines based on implants from a specific vendor? If so, will they be applicable the implant of choice if using a different vendor? Additionally, are these guidelines based on updated implant models or has the vendor altered its catalogue or modified its “profile” assessments since these guidelines were published?

CONCLUSIONS

Implant “profile” is a vendor-based descriptor of the overall silhouette of an implant. It is different from implant projection, which is the quantitative anterior–posterior dimension of the implant. Until “profile” assessments are standardized across implant manufacturers, implant selection guidelines based primarily on “profile” type should be scrutinized before their clinical application. The plastic surgeon must be cognizant of this limitation when utilizing “profile” classifications in the selection of implants for breast augmentation.