The Dr I consulted says I have mild tuberous breasts and recommends silicone implants placed above the muscle and no lift. For both the sternum to nipple line is 21 and the width is 13. Do you agree with these recommendations? Why would he not place sub muscular?
Doctor Answers 15
Subglandular augmentation in ptotic breast
Your breasts are ptotic It does not matter the distance between the sternum and nipple; your niples are well below the crease. if no lift is done you will have worst possible result. Implants can't lift the breast. I would suggest you consider submuscular placement of implants as the existing breast tissue is very thin.
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Breast lift for you!
I am afraid that an implant only procedure for you will result in a rock in a sock deformity. The idea of placing the implants in a subglandular position to help with a lift is compounding a bad idea with another bad idea.
Placing the implant in the subglandular position will increase the rate of sagging and increase your risk of capsule contracture. Furthermore, the edges of the implants will be more obvious, thus making the procedure appear less natural.
My suggestion is to get a circumareolar lift (like my Tear Drop Augmentation Mastopexy) with an appropriate sized submuscular implant.
Please get another opinion
I do not agree with the surgeon you visited with. I have seen many patients who have had breast implants placed over the muscle and the results are usually not what the patient was looking for. Based on your photos, you look like a good candidate for breast augmentation with mastopexy (breast lift). A breast lift involves lifting the nipple-areola complex and removing loose skin to ensure a tightened and perkier look. Breast implants will help achieve more volume and fullness. Based on your body type, I would recommend placing silicone gel implants submuscularly, to provide a more natural look. Implants that are placed under the muscle decrease the risk for encapsulation and rippling and give you a longer lasting result. Breast lifting surgery is tricky and so I would highly recommend getting another opinion and making sure that the surgeon is a board certified plastic surgeon
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Tuberous vs. Sagging Breasts
Based on your photos, you do have one of the components of a tuberous breast in that you have a high breast fold and subsequently a very narrow breast base. You appear to have too much sagging to get a good result with breast augmentation alone. You should have a breast lift with a breast implant placed under the muscle with a silicone gel implant because you appear to have very little "padding". A peri-areolar breast lift would work but but your areolas may be too small to permit insertion of a gel implant without a separate incision (and scar) in the breast fold.
Correction Of Breast Ptosis (Sagging)
In your photo, you certainly appear to have a good deal of breast ptosis or sagging. I do not see significant tuberous breast deformity in the photo. I do not think that you will pleased with an augmentation without a breast lift no matter where the implants are placed. You seem to have little upper pole tissue and would place the implants below the muscle and also perform a breast lift. You might want to consider a second opinion.
My recommendation would be silicone, under the muscle and a lift at the same time. Without a lift, you likely will not be happy with the shape of your breasts or the position of you nipples.
Wrong choice for your breasts
In my opinion, the doctor you saw was completely wrong. Your issue is not "mild" as you have fairly severely droopy and empty breasts. You for sure need a lift because of the downward pointing shape of the breasts. I also prefer to go under the muscle for a better long term look, better mammograms and less capsular contractures I believe.
I at least agree on the silicone part.
Breast Lift Necessary
Tubular Breast Recommendation
A tubular breast has a pointy shape so it will shape up and round better if you go above the muscle. If you are just doing the augmentation I would definitely recommend doing Silicone above the muscle.
Subglandular breast implants
In this case the responses are fairly consistent and correct. Tubular breast is not technically correct but your breast has no lower pole and the nipple-areola level appears to be well below the inframammary crease level and thus requires a mastopexy with or without an implant. This could be done with a vertical or lollipop-type incision although a periareolar mastopexy could be considered. The implant has to be carefully matched to the true width of the breast and carefully positioned along with not being too forward projecting. Extensive experience over many years says that all breast implants should be behind the pectoralis muscle to pad, protect, and blend them in so that they are not visible in the upper pole of the breast. I would start over with an experienced plastic surgeon that understands your need for a mastopexy and subpectoral implants. I doubt you would be happy with a lift alone or an implant without the lift.