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.

Basing the success of breast augmentation on cup size is not advisable as cup size varies considerably from company to company. Implant selection should be a collaboration between the patient based on her needs/objectives and the surgeon based on his or her expertise and experience. The implant placement must match the needs/objectives of the patient, but submuscular tends to benefit most patients. Consult with 3 board certified plastic surgeons to understand your options and choose the one that best understands your needs/goals/objectives and can deliver a beautiful natural looking result. You may be able to achieve the resulting appearance at a smaller cup size.

OK- I think you need to take a step back. I'm concerned that you are looking for something that isn't completely obtainable for you and may disappoint you.  Now I don't have the luxury of having had a conversation with you but, as a Plastic Surgeon who has performed over 4000 cosmetic breast procedures over 18 years I have become pretty good at learning what will make patients happy and what will make them miserable.  First of all, given your frame and height, I don't think even a 500cc implant will bring you to the size you discuss.  Second, understanding the risks/benefits of over/under muscle surgery and silicone/saline implants, I think it would be wrong to push you to an over the muscle placement.  I do think that for you, with such a large implant for your frame, at least 90% of what you see as your breasts will actually be implants...that said, if your breast will be 90% implant then the implant itself better have properties that are soft and believable...so a silicone implant is likely your better choice.  Placing that large an implant under your muscle will be extreme making you look very tight and you will likely have ongoing discomfort.  Your current shape is perfect for an under muscle implant which can give you a great result that looks and feels believable...but may not bring you up more than to the full C's.  Down the line, changing these implants to something larger under the muscle becomes much easier.  To bring you to the DD's will likely require an implant in the 650-750 range and you'd be forced to place it over the muscle which, as I said, I believe would be a mistake for you.

You can't ignore the body you're starting with.  You are not Mrs. Potatohead where your choice of breasts are simply stuck on- the surgeon needs to work with what you're starting with and, in your case I'd think you're hoping to look wonderful...not silly.  I hope this is a help.  Good Luck!  Scott Newman, MD FACS 

Based on your photos, you are getting very poor advice if someone is suggesting 450-500cc implants for you. It is implausible in most women that your accurate measurement is 13 cm wide , and the devices you're talking about would substancially exceed your true breast border. The single most consistent factor in reoperative breast surgeries involving breast implants from the FDA has to do with oversized implants, such as you're considering. Most implants in that range resemble those devices used for breast cancer reconstructive surgery where you're building the volume from scratch off the chest wall and do not work well for best results in breast augmentation or mastopexy-augmentation procedures as they overwhelm the tensile strength of the skin over time.

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. 

There are benefits to both going over or under the muscle.  It really all depends on what you are starting out with. Under the muscle hides the implant better but then you have to deal with all of the muscle activity.  In your particular case I would recommend that you go below the muscle since your frame is rather lean to begin with. 

I'm not sure it's that simple.

There are several factors to consider but I almost always recommend placing the implants under the muscle; it generally looks and feels more natural than implants above the muscle.  So that addresses the first issue.  The next is figuring out what size would be right.  Based on the way you describe yourself I don't know that you'll be able to have a 500 cc implant; you may not have enough tissue available (ie, it may be too tight).  Finally, I'm not sure that you'll be able to get an implant that size - or even close - through an incision in the areola. 

You probably need to balance the site of the incision and the size of the implant - would you prefer a larger implant with the crease incision, or the areolar incision with the smaller implant?  These questions are, of course, things that need to be discussed with your own plastic surgeon. 

But they are addressed in my video, which I've included below.  Balancing all the major factors - but starting with the size implant you want and silicone vs saline - is the most likely way to produce a desirable result in the safest manner.

I hope that this helps, and good luck,

Dr. E

The placement of implants under the muscle is usually my preference for a natural looking contour - no implant ridge at the upper chest wall particularly in someone as thin as you.  There isn't much difference between the 450cc and 500cc implant but I would lean towards the 500cc implant for the "full D" result.  Good luck!