260cc Under or over the Muscle?

Hi, I'm 38 years old, 132 lb and 5'8'. I have breast fed two children and am a B cup. I'd like to increase my size to a C cup and have been recommended 260 or 300cc silicone implants under the muscle, due to not having enough fat tissue to cover the implant. I had a consultation with another surgeon today who recommended 260cc silicone implants over the muscle. He said muscle is very thin and does not provide much extra coverage, and I could end up with double bubble. Which is the right choice?

Doctor Answers 8

Breast Implants Under or Over the Chest Wall Muscle

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Considering your height and weight a "C" would be about perfect. I try to gauge the degree of breast augmentation needed by asking. If you are on a date with 3 other couples, after your augmentation, would you prefer the men to think. 1. Well she obviously had her breast enlarged or 2. She looks great, must be working out or is her hair style different. Most of my patients prefer the second scenario. My approach to breast augmentation has changed drastically over the past 2 years. I feel the saline and traditional silicone gel implant will be obsolete in the near future. My current approach for a 5ft.8",132lb patient with a preop B cup,such as yourself would be.

  1. Subpectoral Placement of a Moderate Profile, High Tension Gel Implant
  2. With your height and weight, you might want to go with a slightly larger implant (300cc/350cc)
  3. I strongly feel that a submuscular placement of the implant is best because of:
  • a more natural shape
  • less chance of scarring around implant
  • easier to detect any breast lumps later

Good Luck

Eau Claire Plastic Surgeon
4.7 out of 5 stars 21 reviews

You may need a lift

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You have told us that you are size B and desire size C.  However, you have not told us your bra size.  If you are 32 or 34 then each 100 cc of implant will correspond to 1 cup size change.  If you are 36 or 38 then each 200 cc of implant will correspond to 1 cup size change.  From this, you can determine what size implants are required to get you to size C.  Silicone gel implants are better than saline implants since they feel and look more natural.  The retro-pectoral position is best because it provides the maximum support of the implant producing long term stability.  You also state that you have breast feed 2 children.  So, you probably have some drooping of your breasts as well as loose skin envelope.  You should consider a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Through only a circumareola incision it is possible to lift your breast tissue high on the chest wall, displacing your breast medially to increase cleavage and reshape your breast to create upper pole fullness.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Thin patients are best advised to have the implants placed under the muscle

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Most plastic surgeons place the implants under the muscle.  Usually this gives a more natural appearance.  This is particularly important for someone thin like you.  The "double bubble" with submuscular placement (same as dual plane) is a myth and you should definitely not worry about that.  I would recommend that you go with the larger size, at least 300 cc.  You don't want to think later, why did I not go with a larger size?  The average volume in my practice is 400 cc and virtually no one comes back to have them replaced with a smaller size.  Preoperative measuring systems tend to produce volumes that are too low.  Be careful not to be overly conservative and have regrets later.  I've attached a link to my website so you can view other patients with similar body characteristics.  Silicone may be preferable if you have very little fatty tissue, but it is not mandatory.  Both saline and silicone implants tend to produce very happy patients!

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 62 reviews

Breast implant size selection

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It is difficult to make any recommendations without a formal physical exam.  I generally prefer a dual plane technique for my breast augmentation procedures.  As per size selection, I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for.

This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.

Hope this helps.

Dr Basu
Houston, TX

Double bubble deformity and implant size

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I think using a small implant in the submuscular position will not result in a double bubble deformity - as long as the implant is not substantially wider than your breast foot print, the infra-mammary fold is preserved, or reconstructed if it is violated, then the DB deformity is not a concern.

Under or over the muscle for BA

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260cc is a modest sized implant, especially with your height and weight. I realize that you only want to go up one cup size, and I think that this size implant will do that, but you need to make sure that you are not expecting too much from the implant. Without a photo it's difficult to say. To answer your question it is perfectly fine to go under the muscle. Even if your muscle is "thin" it will still provide you with additional coverage. In fact, if you are that thin that your doc can really determine that your muscle is also thin, then it's probably even more important to go under the muscle. I think you are at very low risk of a double bubble considering the relative small size of the implant.

Breast implants under the muscle

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Without a photo this doesn't count as advice but unless you had some very unique anatomy, I would go under the muscle for the maximum implant coverage.  Done properly, your risk of a double bubble should be exceedingly small especially if the inframammary crease is not disrupted.

In front of or after the muscle, some insights.

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Whenever possible in front of the muscle will lead to less discomfort in the postoperative period. If the skin is thin and there is a need to ressect partially the skin envelop to improve the breast design, a retro muscular fashion is often advised.

Ronaldo Webster, MD
Brazil Plastic Surgeon

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.