Above or below the muscle
If you want the fake look, then go above the muscle. This will give the rounder look you desire. It will also prevent animation deformity with pectoralis muscle contracture. Good luck. Donald R. Nunn MD Atlanta Plastic Surgeon
Breast implants over or under the muscle
Thank you for your question and posting an appropriate picture. You do seem to be a good candidate for breast augmentation. Based on your picture you may be a candidate for placement of the implant over the muscle, however, at the size that you have mentioned placement of the implant under the muscle would be a better choice. If you decide to have the implants placed over the muscle, textured implants would be a better choice as well. Please discuss these options a the board-certified plastic surgeon
Over or beneath the muscle with implants?
This is one of the most asked questions by patients when considering breast augmentation. There are surgeons who only place implants above, and surgeons who only place implants below the muscle. But there are actually pro's and con's of each approach. One approach is never always superior to the other. Using a textured implant above the muscle can help decrease the risk of capsular contracture if the subglandular option is used. Also, the muscle really doesn't "hold" the implant up as in most cases, including yours, it is likely that the bottom of the muscle will have to be released or you will probably need a mastopexy (breast lift) if it isn't. In athletic patients who work out frequently and have enough soft tissue coverage, the above muscle route can be an excellent choice. Good luck.
It really does. I won't repeat the excellent points that have been made by some about the pros and cons of each approach. I will add the following:
It is important to understand how the volume of implant you select will fit in your lifestyle. It is not absurd to consider jogging, running errands in a brassiere fitted with something that approximates the weight of a breast implant. This can easily be done using some common household items. Don't forget that your ability to function normally is important as well.
Remember that the larger your implants, the more stress your breast tissues will experience over your lifetime. This fact may have implications for future breast surgery such as a breast lift which you may desire later in life.
the implant should always be under the muscle as it is softer, better shape, better support, mammograms are better and the capsular contracture rate is lower.
The best way to pick implant size is based on your breast and chest width and not the volume. As the implants get bigger, they get wider. When the width of the implant fits the width of your chest, it will look nice and fit your frame. If the implants are too small, you will have a gap between them and they may look too far apart. If they are too wide, they will make you look top heavy as they may be too wide and stick well out past the sides of your chest.
There are ways to get a bigger or smaller look.This can be done by picking a different implant profile. The higher the profile, the narrower the base width of the implant. If someone has a very narrow chest and wants to be big, they should consider a higher profile implant. If someone has a broad chest and they do not want to be too big but want to avoid the gap and still have cleavage without projection, they should consider a lower profile implant such as a moderate. There are options in between these such as the moderate plus.
Submusclar or subglandular?
For my breast augmentation patients, placing breast implants beneath the pectoral muscle and the fascia (dual plane) offers the following 3 major advantages:
1) Decreased rate of capsule contracture
2) More tissue to cover the implant to prevent the implant from being easily seen or felt
3) Support of the breast gland by the underlying muscle to diminish future droop
Capsule contracture is the term used to describe the formation of scar tissue around the implant which, when thickened, can make the implant feel hard and round. Although the implant itself remains soft, the scar tissue "squeezes" the implant, which makes the implant itself feel hard. In the submuscular position, the rate of capsule contracture is decreased in general from 15% to 3%. That's a significant difference.
"Rippling" occurs when the implant shell is easily felt beneath the skin. With subglandular augmentation, the possibility of this occurring is greater than with the submuscular position. Large studies have shown that the chance of "rippling" is 3 times greater with subglandular augmentation than with submuscular augmentation. Additionally, when implants are placed in the submuscular position "there is the important added advantage of improved mammography."
Separating the breast gland from the underlying muscle removes one of the breast "supports." This can lead to accelerated breast droop. Also, by removing the blood supply from the undersurface of the breast, a future breast lift will be more difficult if needed.
The advantage of the subglandular placement is that the postoperative recovery is generally shortened by several days and the patient may experience less postoperative discomfort. In addition, there will be less motion of the implant with forceful pectoral contracture.
All things considered, the submuscular placement of an implant is the least at risk for the complications of capsule contracture, "rippling" and breast droop.
Over or under the muscle?
The problems with implants above the muscle (sublgandular) from an aesthetic point of view in someone as thin as you is a sharp unnatural transition between the chest wall and the implant which will develop over time in a high percentage of cases as the swelling completely subsides over many months. Although it is impossible to avoid some animation deformity with a submuscular implant, if a dual plane position is used, in my experience patients find it quite acceptable. I do think for an athletic patient, you are choosing a large implant, and certainly for activities like running you may find them to be uncomfortably large. Another point to consider is mammography which is routinely done after the age of 40. With subglandular implants a substantial part of the breast is obscured which is not optimal in terms of breast cancer detection. I think you need to have more discussion with your surgeon both in terms of position and size.
Sub Glandular Breast Implant in an Athletic Person
Although it is impossible to tell from your picture, I would highly discourage someone who looks as petite as you going 500 cc. However, because you are athletic, I would never place an implant under your muscle, especially if you are going to use a large implant. They will be a problem always, not just during healing.
Modest ptosis best corrected with sub glandular implants.
I would recommend sub glandular silicone gel implants. There appears to be some modest ptosis of the breasts which is better corrected in a sub glandular position. Sub glandular augmentation hurts less and there is a lower incidence of bottoming out long-term.
two choices for breast implant placement: sub-glandular (under the breast
tissue and in front of the chest muscle – the pectoralis muscle) or
sub-muscular (under or partially under the chest muscle). The best location
depends on many factors including: tissue thickness, weight, desired outcome,
and individual anatomy. Each position has advantages and disadvantages:
shorter recovery time.
distortion of the breast when the pectoralis muscle flexes.
preoperative sagging can be improved, especially if no breast lifting procedure
implants can be placed.
implant may be more visible.
visible rippling, especially in patients with a small amount of natural breast
saline implants do not produce a good result in front of the muscle.
incidence of capsular contraction.
out” in some patients.
radiologists have more problems reading a mammogram with an implant in front of
Submuscular implant benefits:
results in a better appearance for naturally small breasted women
tendency for seeing ripples of the implant.
more natural feel to the breast especially in slender women who don’t have much
of their own breast tissue.
interference with mammograms, although most radiologists take additional views
no matter where the implants are placed.
rate of capsular contraction.
of a chance of “bottoming out” where the implant bulges at the lower aspect of
the breast and the nipple and areolas tend to appear excessively elevated.
usually takes a little longer and is more uncomfortable initially.
may be an “animation deformity”, which is a temporary distortion of the breasts
when the pectoralis muscle is flexed. Body builders and weight lifters
generally prefer implants in front of the muscle.
is harder to achieve cleavage in women who have widely spaced breasts.
implants often ride higher on the chest.
most patients who have breast augmentations today have breast implants placed
in a combination or “dual plane” position. This approach has the same benefits
and disadvantages of a total “submuscular implant”, but with a lesser tendency
to ride high on the chest wall. The disadvantage as compared to a total
“submuscular implant” is a higher tendency for bottoming out.
placement in any particular patient depends on their particular anatomy and
understanding of the pros and cons of each approach.
in mind, that following the advice from a surgeon on this or any other website
who proposes to tell you what to do based on two dimensional photos without
examining you, physically feeling the tissue, assessing your desired outcome,
taking a full medical history, and discussing the pros and cons of each
operative procedure may not be in your best interest. I would suggest you find
a plastic surgeon certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS)
that you trust and are comfortable with. You should discuss your concerns with
that surgeon in person.
Singer, MD FACS