500cc Silicone, Under or over Muscle?

Hello Curiouslatina,

I'm not sure if you meant to re-post your question or if you just didn't like that answers you were given the first time!  As most of the surgeons who responded to your original post had said, including me, under the muscle is almost always the best place to put the implant. You will get a lot of projection and the muscle will provide a cushion to help make the implant both look and feel good.  Sub-muscularly placed implants also have a lower risk of capsular contracture, the most common complication after breast augmentation.

Your areola are relatively small, so I don't recommend an areolar incision.  You are an ideal candidate for an armpit incision.  This will give you a virtually invisible scar in the armpit that looks like a natural crease, and recovery is identical to an areolar incision.

Although there is not a lot of difference between 450 cc and 500 cc, I think that 450 cc would be best suited for your frame, tissue thickness, and probably your goal in terms of your appearance.

Best of luck.

I would generally recommend placement of the implants under the muscle.  I believe this is especially true in thin patients (like you).   Sub-muscular placement increases the amount of soft-tissue between your implants and the skin and may decrease the rate of capsular contracture.

To better communicate with your surgeon your desires in terms of size, I would recommend that you show him/her the above photographs.  Based on your apparent goals and base diameter, I would likely place the 500 cc implant.  The Allergan high profile 500 cc implant has a base diameter of 13 cm.  You should realize, however, that the difference between 450 cc and 500 cc is less than 2 ounces.  Meet again with the surgeons and show them photographs of breast sizes that you feel are desirable.  Good luck.

 

Clear communication with your surgeon is  very important  in maximizing the chances of achieving your desired breast size.  Demonstrating your goals in front of a full-length mirror is helpful.

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is also very helpful. I have found that the use of words such as “natural” or “C cup” means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. 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.