I have above-muscle saline implants(270L/330R) since 1994. I had tuberous breasts. I am 5'9, 155 pds. My breasts are very far apart (5 fingers). I want appx 550cc silicone. My doctor would like to leave them above-muscle and have them be mod+ profile. I know that mods are wider than mod +. He says mods are flat like pancakes. Does mod + sound right for me? How about his desire to leave them above-muscle? Nearly all his procedures are submuscular. Won't I sag? I am 38 yrs old
Implant Profile and Position Dilemma
Doctor Answers (12)
Avoiding excessively large implants in patients with cosntrcted breasts
I have concerns that you would be at particularly high risk for a doublte bubble deformity because you commneced the augmentation with previously small constricted breasts.
Recommend switching breast implants to submuscular
It is very difficult to give you my full recommendations without seeing you in consultation; however, from your description, it sounds like the "5 finger" space between your breasts is something I see very typically with breast implants placed on top of the muscle. By switching the implants to the submuscular or subpectoral pocket (under the muscle), the cleavage area or space between the breast will be better, closer, and more natural appearing. In addition, it is sometimes necessary to use a wider profile implant, sometimes even a low profile implant...This part depends on your measurements. Pocket conversion (switching the implant from on top to below the muscle) can be a challenging and technical operation and it is important that you select a board certified plastic surgeon with experience in reoperative breast implant surgery. I hope this helps!
James F. Boynton, M.D., F.A.C.S.
Tuberous breast , augmentation
Tuberous breast are a difficult problem for all to treat .The results are more difficult to predict and a great result is usually not expected. Without pictures or an exam it would be very hard to tell what is best in your case.
Cosmetic Surgery in cases like this as in most is best done by a Board Certified Plastic Surgeon.
The separation in the middle is largely determined by rib / chest shape and in a tuberous breast the skin has to stretch open to get a good position medially, The style of implant helps some but there are other factors.
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Implant profile needs to be individualized
In general the larger the implant the larger the diameter of the implant. Several years ago manufacturers gave us more selections in choosing implants size and the diameter of the implant to best fit your body build. Also switching from above muscle position to under the muscle is not as easy as it sounds, especially when you are increasing the size as much as you want. A thorough exam and discussion with your surgeon is very important.
Breast implant revision
Without examining you, it is really a tough call to make to tell you what implant would be best for you.
Implant style and Position
I tend to agree with some of your assessments. I do prefer moderate profile implants in the situation of tuberous breasts, as they tend to narrow the cleavage space and increase the base width of the breast. However, it is dependent on your goal cup size. Your surgeon needs to satisfy that, while ensuring your implant diameter fits within your frame. I also prefer submuscular placement, however, you may need some tissue tightening in the form of a small or moderate breast lift to be a candidate. I find sagging irrespective of pocket site, and more related to implant size and a patient's inherent tissue tone in supporting the implant weight.
Implant Profile and Position Dilemma
I am concerned that your "surgeon" is not a plastic surgeon! Here in MIAMI board certified plastic surgeons would replace in the submuscular plane in most cases. The only reason I could see leaving in the "above muscle" position is the result you have. You did not post photos so hard to tell. The size is acceptable. I think you need more opinions. Call my office for a free evaluation. Regards Dr. B
Replacement of Implants- Better under the muscle for most women
For most women, the short and long term outcomes are better if implants are placed partially submuscular. The recovery will be a bit more difficult, and the operation is definitely a bit more challenging for the surgeon, but the benefits are real.
As far as profiles and volumes, I actually do not believe that the profile is choice for you to make based on your desired appearance, so much as it is a matter of choosing an implant that is appropriate for your body's size and dimensions.
You can understand this a bit better by reading this:
Breast Implants Come in Many Shapes and Sizes -like women.
It is wonderful that you are so well informed about the many options available for breast augmentation.
Every patient is unique, and your case even more so with the tuberous deformity and asymmetry.
In consultation with your plastic surgeon, you can select the best choice for you. It does sound like you are increasing the size quite a bit, and this is a concerm for future sagging.
Implant position and profile dilemma
We feel that submuscular coverage is the better approach in a thin breast where the current implant 'shows through' the skin and breast tissue. Replacement of your implants into a submuscular position is more difficult in terms of recovery, but is probably worth the effort. The wide space between your breast may be natural, due to a capsule with your current implants, or related to the diameter and profile of your implants. With a 'new' pocket and an implant with a wider diameter your result could be better. The 550 cc implant is certainly large though a reasonable next step from a 330 cc implant. The moderate verses the moderate plus, you will not be able to tell the difference.
Best of luck,