I am 35 year old mother of two breast fed infants left with with saggy size B breasts. I keep reading that UNDER the muscle is a better choice but my surgeon has recommended a breast lift with over the muscle implants. WHY?
Over or Under with a Lift? (photo)
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Breast Lift With Implant Under Muscle Possible
Thank you for your question. Most plastic surgeons today prefer to place breast implants beneath the chest muscle to provide better coverage of the implant, easier mammogram examination, and possibly less saging or chance of capsular contraction with time.
After pregnancy the breast atrophies, loses volume, and sags and from your photographs it appears that you have significant sagging or ptosis although an examination in person is required for accuracy.
In patients with significant breast sag or ptosis a breast lift must be done if the breast implant is to be placed beneath the chest muscle in most cases. Both breast lift and breast augmentation can be done at the same operation however many surgeons prefer to do the breast implant first, allow the implant to settle, and after 3-6 months the breast lift can be done to more accurately position the nipple and areola over the implant in an optimal location.
In some cases, if you are luckey, the implant will settle into the breast and a lift may not be necessary after 3-6 months.
For patients who do not want a breast lift, many surgeons prefer to place the implant over the muscle beneath the breast gland to allow the implant to settle lower into the breast and avoid a lift..
Both procedures will work in most cases however I think most surgeons today would prefer sub-muscular breast augmentation and dermal mastopexy or breast lift. However the choices yours as long as you are fully infrmed and understand the difference and long term indications. The link below explains this more clearly.
Be sure to consult a plastic surgeons who are certified by the American Board of Plastic Surgery, are experienced in cosmetic breast surgery, and have an excellent reputation in your community
Thanks for providing your photograph.
Really difficult to tell without examining you how much tissue coverage you have for an implant above the muscle. But from the photo alone it looks like you would be a candidate for dual plane under the muscle and you won't need a breast lift. It is to your advantage to avoid a breast lift if you don't really need it; less visible scars and fewer overall complications when the breast is being enlarged in the same operation.
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Your surgeon's preference
is the most likely reason why over the muscle was recommended. With dual plane techniques, the theoretical 'advantages' of lifting more with on top of the muscle no longer exist. When I compare my dual plane techniques with another surgeon in town who goes above the muscle, I know my result have better long term results... and that is what the word on the street is. So it really comes down to your surgeons preference. Otherwise going under the muscle give you more fullness on top, prevents rippling on top, better mammograms where implant is under muscle and the biggest reason, less risk for contractures under the muscle... but the breasts move with chest muscle contraction.
Breast Implants with a Lift: Under or Over the Muscle?
Mothers may find that pregnancy and breastfeeding contribute to loss of volume and firmness. To perk up a drooping breast, your surgeon will remove excess skin, reposition the nipple, and redrape and tighten the remaining skin to support the breast. The areola may also be reduced in size. A mastopexy (breast lift) raises droopy breasts from one to several inches and excess skin is removed. If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants.
If you want the most natural-looking breast you'll need a subpectoral implant, in which the implant is placed under the muscle. This procedure diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant which occurs in 10 to 30 percent of cases. Subpectoral implants aren't right for everyone, though. If you have saggy breasts, and implant placed under the muscle won't fill out that empty breast sack, and you'll get what we call the "double bubble" look, where the implant is situated next to your armpit and the breast hangs several inches below it.
It is now possible with the newest technique for you to enlarge your breasts without resorting to implants! Specially prepared fat taken from another part of the body, such as the stomach or hips, is placed under the breast tissue to provide increased breast size without the need for artificial implants. The technique is called autologous fat transfers and autologous simply means "your own." And who doesn't have a little fat to spare?
In short, you must know -- realistically -- what you are starting with, as well as what you want to look like when surgery is done. Do you want a natural appearance or a round, perky look? These are some of the factors I weigh with my patients when evaluating what type of procedure to do.
Implants with concurrent mastopexy should be placed below the muscle
In my opinion breast implants placed at the same time as a mastopexy should be placed below the muscle. This has nothing to do with aesthetics but rather preserving adequate blood supply to the nipple areolar complex to prevent vascular damage.
Under or over with lift
My recommendation is under the muscle , for many reasons that others had already explained .
Your personal conditions : skin , mamary gland tissue , and position of your nipple areola complex the more logical option is under the muscle ,an implant over the muscle will be great ate the first 3 months but then the action of the implant to this skin and poor mamary tissue wil end up , in a saggy breast with eventual palpation of implant . it is much easier for a plastic surgeon to place an implant over muscle but in long terms will not be the best decision.
Lift with implants and pocket location
I prefer in most cases to place the implants under the muscle especially in women that have very thin soft tissue coverage.
Under muscle better
Based on your picture and apparent skin laxity my preference is a dual plane sub muscular implant placement. The results last longer and look better in my opinion. You may benefit from another consultation with a board certified plastic surgeon.
Over or Under Pectoralis Major Muscle with a Lift?
Thank you for the question and picture. I would strongly recommend that you choose the sub pectoral ( dual plane) positioning of breast implants for many reasons. I cannot speculate as to why your plastic surgeon is recommending otherwise.
I will try to outline some of the differences here; you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in these sub muscular position.
Again, in your case, given the lack of significant soft tissue coverage, I would suggest the sub muscular ( dual plane) positioning.