John Noonan, MD (retired)

I place the majority of my breast implants under the muscle ( sub-pectoral). Although each patient needs an evaluation to ultimately decide which site will work best for them, most will opt for under the muscle after their consultation. There are multiple reasons why I prefer sub- muscular (especially for a patient with a petite frame) : under the muscle the implant feels more natural as it is covered by more of the patients own tissue; there is a more natural slope from chest wall to breast; less rippling of the implant ; there is less chance for heavy scarring around the implant. This scarring can lead to a firm hard feeling to the implant (capsular contracture).

Placing the implant above the muscle decreases post operative discomfort and avoids distortion of the implant by muscle contraction. These are some pros and cons. The best advice is to discuss your concerns with a board certified plastic surgeon. I hope this helps. Good luck  

It sounds like you are a good candidate for an abdominoplasty;- although losing 17 pounds since your pre-op evaluation is a remarkable feat. I 'm sure that you have discussed this weight loss as well as your contouring concerns with your surgeon. If not , please do so.  If you were a candidate for a full abdominoplasty before the weight loss, you should still be a good candidate now. But remember the objective is to give you the best results not the biggest surgery.  ...and congrats on the weight loss! It's always best to loose excess weight pre-op (if you can). This will be a benefit to both you and your surgeon. Your anesthesia risks are lowered and surgical contouring is technically easier. You might ask your anesthetist about a scopolamine patch which might deminish post op nausea and vomiting.

Good luck 

There are modest gains that can be accomplished given your history. Exercise, diet and Cool Sculpt would be a good start. Cool Sculpt removes fat by lowering the temperature in the problem areas. The underlying fat dissolves over the course of months and the skin tightens. You can expect about a 15-20% reduction of fat per area treated. However, after 3 pregnancies, you probably have at least a few stretch marks. These decrease the skin's ability to tighten; possibly leading to more loose skin after the fat dissolves. This coupled with a lower abdominal scar from the 3 C-sections further decreases your chances of losing that pouch without surgical intervention.  

In 10 years there may be many non-surgical methods to solve your problem but presently the best solution is still surgery or a combination of weight loss, suction assisted fat removal and surgical skin/muscle tightening. Remember, your abdominal muscles have also been stretched by the preganancies.  Discuss your options, as well as the pros- and cons to surgery, with a board certified plastic surgeon. I'm sure that the consultation will enable you to make the right choice.

You might think that you chose the wrong size but give it time. Overfilling the implants to 400cc. should give you close to a two cup size increase unless you have a very wide chest.

There are several reasons that you might feel that the improvement is less than you imagined. Your chest muscles need time to relax and stretch. If you are very athletic, the muscles are going to take a longer time to do this. Sometimes the new bra might not be a good fit and you might experiment with various types, and occasionally " friends" mean well but can be say the wrong thing at the wrong time. The fact that you and your surgeon both felt that this volume would give you the appearance that you desired lead me to believe that in time you should both be happy. Give it at least 4-5 month, and keep your surgeon informed.