Plastic surgeon red flags?

It seems that the PS and you are just a little different. You like to be in the loop about what is happening and he is the type that tells you just to trust him. He could have at least explained how he picks an implant for you and what affects the choice. My surgeon had 3 types of implants available during surgery and picked from them. It is easiest to decide about size by just filling the tissue expanders until you like them and not to get an idea in your head about specific cc's. Most doctors probably have their favorite brand or type of implant they like to work with. You can achieve different looks with the same implant too, it depends on how they make the pocket. The same implant can give you the "porn star" look or a more natural teardrop look. When it comes to projection it largely depends on how large you want to go in relation to the size of your ribgage, the only way to get large implants on small ribgage is to go with high profile implants.

You should pick a surgeon you are comfortable with, if you like to know all the ins and outs then you need to go with somebody who will explain the whole process better. The first surgeon may not have been bad but he just had a different work style. I hope you like the other surgeon better. And it helps to do your own homework and research since the surgeon may not bring up points that are important to you.

My surgeon said the same thing about the rounds ending up shaped like the anatomical, although he did use the anatomical. Also when pushed about a different type of implant he said offices tend to use one brand. He politically correctly explained what sounded like a quantity discount to me if they use a lot of them, so they push that brand (but gave me a different one). I was also asked about the size and was told something similar to what you were.

I spent more time with the plastic surgeon than my breast surgeon, so you will want to keep looking until you find one you like and are comfortable with.

I am glad you had a better visit with PS #2. Every PS is different, and everyone needs to find their "fit". You will be starting a long relationship with them, which can include many visits and so on so you need that comfort and confidence!

Not working with anatomicals is not necessarily a sign, some just prefer not to, but I did for myself want a PS experienced with various forms of recon, including both tissue expanders and direct to implant, and both rounds and anatomicals, so we could come up with best plan for me based on me and my circumstances, not based on his limitations and products. Make sense?

Your tissue expanders will be selected on your measurements, their purpose is to stretch the tissues not necessarily look pretty or even. You should check out Breast Implant Sizing 101, as there IS a difference going from expanders to implants....even for the same volume implant you can expect to look smaller/have less projection as expanders have hard backs and project more off ribcage...implants are soft and conform more. If you want projection, you need to look at higher projection implants, but there are limits as you need to consider your chest diameter too so you don't end up with a funny looking narrow high projection implant!

My first surgery we did direct to implant with rounds. I let my PS know my size preferences (i.e. same or smaller than I was) and he brought 3 different sets of round implants (plus spares) to OR based on my body measurements and our discussions. He used sizers during surgery to determine best one to use. For my exchange we switched to anatomicals and, again, we talked about what I liked and did not like about current implants, and he brought in 6 sets of implants and spares to OR (all anatomicals) per my measurements and current implant dimensions to determine what fit best in pocket and looked best.

The risk with anatomicals shifting in pocket is actually quite minimal (like less than 1-2%) if properly placed and pocket is properly made (snug), they are textured to allow adherence to the tissues so it is very important to follow PS instructions in early weeks to allow this adherence. These early weeks really affect whether the implant will rotate then or in the future. To me the lower risk of capsular contracture and the reduced rippling I got, and better shape, all outweigh that low risk of rotation (and I made sure to follow my PS instructions in early weeks to make sure they "stuck" in place). You definitely want a PS who is trained and experienced in placing anatomicals though, whether you need expansion or do direct to implant.