I am a very thin woman with deflated A breasts after breastfeeding. My nipples are in good position but I have lots of extra skin. I scar poorly so do not want to remove skin. Doctor is recommending teardrop natrelle implants in the subglandular position. I read that round smooth implants in the submuscular position is the better choice. My surgeon says that since I am so thin (my 7th ribs are visible) my muscle will not help with coverage and round implants will appear 'round'. What do u think?
Please Help I Am So Confused with Implant Types?
Doctor Answers 13
Round Implants under the Muscle or Implants over the Muscle
Most augmentations in this country are done on women with very little breast tissue. This tends to make breast augmentation with submuscular implants more common as this provides for camouflage for implant and potential rippling.
Very Thin Chest. Above or Below the Muscle.
Hello, and thank you for your question,
Since you are very thin with visible ribs, I would use a lot of caution in placing an implant in the subglandular or subfascial position. It doesn't take much to cause rippling in the upper and inside part of the breast, especially if there is a lot of laxity of the tissue. While a good physical exam is necessary to give you a good opinion on this, I would certainly lean towards placing your implants in the subpectoral position. As to choice of implants, you probably won't go wrong with either round or shaped implants, althought he more solid the implant (form stable vs. silicone memory gel) with the form stable being the more solid implant, the less likely you are to have rippling.
Pablo Prichard, MD
Breast augmentation options
Thank you for the question. Your first decision will be to decide on whether you need a lift or whether an implant alone will provide the results that you want. Using an implant to address a breast lift issue, should you need it, is not a wise decision in my humble opinion. In terms of breast implants, thin breast tissue that has gone through pregnancy/breast feeding usually is best served by placing the implant under the muscle. I have performed sub-fascial augmentation in such situations and have gotten good results but the implants were easily palpable. Form stable implants (shaped) may be a good option but require very careful placement as rotation of the implant can occur and will result in asymmetry. Discuss all of these issues with at least a few board certified plastic surgeons to get an idea of what would serve you best.
All the best,
Dr Remus Repta
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Breast augmentation in thin patients
1. You need to be examined in person to definitively assess you for the best options for breast augmentation, and that being said,
2. Subglandular teardrops would NOT be my choice. There is ample data to suggest that subglandular augmentation carries the highest risk of capsular contracture. It is true that patients who refuse a mastopexy may need to accept this increased capcon risk if they do not want skin removal, so that the implant will drop with the breast tissue. I believe this is a suboptimal aesthetic result from a shaping standpoint, in most cases. It is basically trading a more aesthetic position for the implant and nipple for less scarring and a more sagging (although natural) position of the implant. I usually counsel patients to accept the scar (which is usually quite satisfactory) of a vertical or other type of mastopexy (lift) in order to let us put the implant into a position (submuscular or dual plane) that allows for a lower capsular contracture rate and a greater amount of tissue coverage. Thin patients, in particular, have little tissue to shroud the implant in the subglandular position, which likely contributes to the capcon rates and also leads to more palpability and detectability of the device.
Thin and wanting implants.
From what you are describing, I believe going under the muscle is still a good option. Even though your muscle may indeed be thin - under muscle augmentation - has been shown to lower risks of contracture with smooth implants. I hope this helps - Dr. Aldo.
I think the bigger issue is implant position. In a thin patient such as yourself, having more tissue over the implant is quite important. The chances of capsular contracture are diminished, the chances of ripples that are visible are diminished. I see no counteracting advantages of placing the implants above the muscle.
I concur with your feeling that smooth round implants are most natural.
Getting additional opinions is often useful, particularly if you have reason not to concur with the recommendation you have received.
Thanks, best wishes.
I am not a fan of subglandular implants for most patients and definately not the tear drop shaped in the subglandular position. These tear drops are great for very tall patients with a long torso
I think you answered your own question. If you want round implants under the muscle, that sounds reasonable. I personally am not a big fan of teardrop shaped implants over the muscle.
Implant Shape and Position
While some doctors believe that subglandular silicone implants are a reasonable choice for your situation, the likelihood of capsular contracture and palpability of the implant are higher with subglandular placement. In addition, textured surface implants in thin tissue in the subglandular position will sometimes cause visible waviness to the skin when you are supine. For these reasons, I would recommend subpectoral placement.
As you have described yourself as very thin with small deflated breasts, several options need to be considered. I personally would suggest submuscular placement of the implants to reduce the risk of rippling and capsular contracture. If you need to elevate the nipple/areolar complex and don't want a large implant that might be too wide, the Moderate Plus profile might be a good choice for you. Lastly, consider a silicone implant for the benefit of a somewhat more natural feel. If your surgeon can show you with 3D computer imaging the predicted results with various style implants you might be better able to make a decision that you are comfortable with . All the best!