I Need Some Advice About 500 Cc's Saline Implant Placement. Above or Below Muscle?

I've had 2 consults with 2 diff PSs & they both had diff suggestions.The first PS suggested Cresent Lift,500cc Saline Anatomical Implant placed over the muscle.The 2nd PS was completely against a cresent & an anatomical implant & suggested Benelli Lift, 500cc Saline implant placed under the muscle.I've done so much reading & research and I'm just left feeling more confused than before! Initially I thought a 500cc Saline implant under the muscle with a Cresent Lift would be my answer...HELP! :)

Doctor Answers 12

Always below the muscle

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I always place the implants below the muscle for more support, long term stability and less capsular contracture.  500 cc implant weighs more than 1 lb, may be too heavy for you, may give you a larger size than you desire and will descend faster than smaller implants.  Smaller implants placed high may give the youthful projection that you desire.  I would definately avoid implants in front of the muscle as they will descend more rapidly and the added weight will stretch your skin. Re-arranging your current breast tissue to lie directly above a smaller implant and making a circumareolar incision to reposition the nipple/areola complex will help in achieving a more natural appearance. Ofcourse, submitting actual photos will help give you more accurate advice!

Best of Luck,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Breast implants, lifts, and positioning

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I will be a bit more definite in my opinion based on many years of experience with all types of augmentations and lifts. So-called "crescent lifts" are a misconception, don't lift the breast, and have been abandoned long ago by experienced plastic surgeons. If you truly need a lift it needs to be done properly. Anatomic shaped implants are almost never needed in cosmetic breast augmentation and have potential problems that can be avoided by round, smooth surface implants. All the experience suggests that implants do better short term and long term if they are properly placed below the pectoralis major muscle. Saline-filled breast implants have a number of advantages but they don't look or feel natural above the pectoralis muscle. Proper sizing for implants is not done by picking an implant size and working backwards. The number of cc's is determined by finding the width of the implant that will fit your breast width and then choosing a forward profile to increase your breast size by about 1 - 2 cup sizes. You can then look this up and find how many cc's the implant is rated. You don't go to the shoe store and pick a size shoe and make it fit your foot, you measure your foot and see what size shoe will fit it. Unfortunately breast implants can not be tried on like a shoe and external methods of sizing are quite misleading. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast Position, Implants, and Lift

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While an in person recommendation and exam is warranted to provide the best recommendation, my experience suggests that very few patients are candidates for a crescent lift and anatomical implants are too problematic to use. Submuscular position is my generally preferred position unless a patient's case suggests otherwise.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews


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As far  as placement of a saline implant above or below the muscle, I favor sub muscular placement. The reason  is that saline implants tend to ripple in the upper portion. Submuscular placement of the implant will cover  up this rippling.  If the implant is in front of the muscle, rippling may be seen  through the skin especially if you are very thin.  This is even more likely with a larger implant, such as 500 cc's or more.  As far as a crescent or Benelli lift are concerned, I'm not crazy about either. They do not give much lift at all and are likely to stretch out the areole over time. Combine this with a very large implant, and you will end up with breasts that are saggier than before. maybe not right away but certainly over time.  You may be better off with a vertical or full mastopexy with a smaller implants. Consider resubmitting you question with photos.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Implant placement

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A 500 cc saline implant is going to be quite heavy and I would predict that your chances of the implant "bottoming out" over time is very high. A crescentic lift will strecth out and look unsightly over time. The submuscular placement is the better option but do consider using not so large implants. If you really want that volume I would recommend gel implants instead.

Ann F. Reilley, MD (retired)
Baton Rouge Plastic Surgeon

500 cc implants

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It is difficult to tell you what would be best for you without an exam. I usually place implants below the muscle for patients that are very thin.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

500cc Saline Implant, Above or Below Muscle?

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As others have stated, photos are really needed to begin to give you informed advice. That said, I think that some discussion about the options you have been given may be useful.

It sounds as if you are needing a lift, and understandably are concerned with the scars that come with a lift. A 500 cc implant is a reasonably large implant, depending on your frame. My guess is that the surgeons are trying to avoid a full lift by using a larger implant and then performing a lessor type of lift. This is almost always a bad idea as it results in a breast that's not well shaped, and you are usually better off with the extra scar.

In my opinion, the crescent lift is worthless. It accomplishes virtually nothing in terms of lifting and almost always results in an elongated and irregular areola. Binelli lifts are also limited in their application. They do not accomplish much lifting, the areolar scar often widens and is irregular, and the lift, by it's nature, tends to flatten the breast. So unless you have a cone shaped breast, a Binelli lift will not give you a perkier more projecting breast that you likely desire.

Now, about that 500cc implant on top of the muscle. As noted, that is a larger implant. If placed on top of the muscle, due to size and weight, the implant will stretch out the breast tissues and quickly descend. The result will be a large saggy breast with thin tissue coverage, resulting in an easily palpable implant and likely visible rippling. Is this the result that you are looking for? Likely not.

Anatomic implant under the muscle - also fraught with potential problems. Anatomic implants can and do rotate, resulting an unsatisfactory breast shape. These implants are textured to supposedly prevent them from rotating. A texturized implant surface is thicker, hence it feels more firm - another downside.

My suggestion is that you get another opinion or two and be willing to accept a more comprehensive lift if that is indicated. When done well the results can be quite good.

Saline implant placement

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The saline implant, especially a fuller one will ripple less and look better over time if under the muscle. The anatomic saline will not hold shape and will behave as a round imlant, and we bet very few would use one. Lastly, the full round block lift is more effective than a crescent lift. Many of us no longer do a crescent lift. My vote is with doctor #2.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

500 cc implants, above or below the muscle

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I agree with the others, photos would be helpful, but more important, measurements of your base width and tissue charcteristics are essential in recommendation of a size.

As for above or below the muscle, I believe that these days, there is no indication that I can think of to go above the muscle. Pretty strong statement, yes. For those with moderate glandular ptosis (drooping) a Dual plane II or III procedure takes care of the problem. If you go submuscular, then you have more soft tissue above the implant to give a more natural look and feel, as well as less interference with mammography (based upon what my radiology colleagues have told me).

If there is more severe ptosis or 3rd degree nipple ptosis (pointing down), then a lift is often required. I am not a fan of periareolar lifts; all they do is drag the nipple/areola complex upward, they do not do anything to remodel or elevate the lower part of the breast to any appreciable degree. Furthermore, if you look at the mechanical forces on the periareolar scar when a lift is performed, there is more tension on it radially, and I think that leads to more visible, thicker scars. A short scar technqiue ("lollipop") does add a vertical scar between the areola and the lower crease, but it gives you a much better lift, the mechanical forces on the periareolar portion of the scar are much more favorable with less visible scars and the vertical scar usually heals very well.

Mark D. Epstein, MD
Stony Brook Plastic Surgeon
4.9 out of 5 stars 244 reviews

Breast Implant Placement

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Without pictures or seeing you in person, it is impossible for us to give you specific advice.  In general in my opinion, silicone implants placed under the muscle give the most natural looking results.  However, the surgery must be tailored to each patients specific anatomy to obtain the most natural results.


Good Luck.

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.