When I had the consult with my plastic surgeon he had a 450 cc implant to show me (will try on the sizers at pre op) and we all agreed it looked plenty big to bring me from a natural C to a DD. He suggested I go bigger, with 500 cc HP silicone under the muscle. I've heard some doctors add 50 cc to try to compensate for "losing cc's" by going under the muscle. Is this true? I feel 500 is too big for me and 450 was perfect, but if I'll "lose" some I'd rather go with the larger size.
Losing Cc's Under the Muscle?
Doctor Answers 8
Yes it is true; in our practice we do the same. Once the implant is placed under the muscle it does compress it, so to give you what you are looking at outside your clothes adding a few more cc its makes up for the difference.
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The selection of an implant is an imperfect science
There are many ways for patients and surgeons to choose implants- and none of them are perfect.
If your surgeon has indicated to you that with his understanding of your goals and your anatomy, in his experience what he is recommending to you would result in a close approximation of your goal, and you trust that you have chosen the best surgeon you could (and for the right reasons), then I would trust his recommendations.
Implant choices under the muscle
I usually go with the size that is agreed upon with the patient. 50 cc may not be a significant difference and once things relax they often look better.
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Does submuscular placement of implants effectively decrease the volume?
I believe that initially, submuscular placement does appear to decrease the effective volume of breast implants. But, after a variable amount of time, the original muscle tightness loosens, and the chosen volume appears. This is certainly an individual process, so varies patient to patient. I don't add volume to the size the patient chooses.
Under the muscle breast implants and size
It is difficult to predict breast size after augmentation, no matter which technique is used. The Mentor company camy out with a new sizer system this past spring that seems to make pre-operative sizing a lot more direct; in other words, 400 cc sizer looks close to what a 400 cc implant is like under the muscle.
Until we started using this new system, we would routinely suggest to patients that they go up in size 25 to 50 cc. Hope this helps.
Size and Implant Position
Photographs would be helpful, but based on your description, your current size (C cup) and your doctor's recommendation for a larger implant than you want makes me concerned that you might need a breast lift in addition to a breast implant. I would make sure the doctor you've seen is certified by the ABPS and is also a member of the ASAPS. Additionally, he should be expert in all forms of aesthetic breast surgery like breast lifts, reductions, and revisions, not just breast augmentation. You'd be doing yourself a favor if you have another consult with someone of that caliber.
I would be less concerned about the potential effects of subpectoral placement of the implant on your ultimate size; there is no 'standardized' amount of apparent volume loss, and it should not come into the equation of deciding on the proper sized implant. Similarly, you should not decide on implant position (above or below the pectoralis muscle) based on how it affects your ultimate size, or the amount of sagging in your breast.
Best of luck!
Volume and under the muscle?
After several years of submuscular implant placement, I have come to the conclusion that there is so much variability even from one side of a patient's breasts, and chest wall and muscles-that I can not say that 50ccs will correct that difference. My best advice is to work with the base dimension of your breast measurement and find an implant that corresponds to that measurement.
Selecting Best Breasts Implants to Meet My Goals?
Thank you for the question.
I do not think that there is any specific rule of thumb that can be used in regards to “losing cc's” by going under the pectoralis muscle with breast implants. Furthermore, the use of sizers under the bra ( although interesting to patients) is not necessarily an accurate way to predict exactly what breasts implant size/profile will best meet the patient's goals.
In my practice, I would ask that you show me lots of pictures of breast sizes that you would like to achieve ( and some that are too big or too small). This communication with the help of pictures is more accurate than discussing cup sizes ( which can vary from one bra manufacturer to another) or communicating with words such as “natural” ( which may mean different things to different people).
During surgery, I use temporary sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
I hope this helps.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.