Small (36A), pointy breasts. Are above the muscle, "gummy-bear" implants ideal?

I'm no fitness freak, but I enjoy working out/ lifting weights; hence was told above the muscle would be better. But would the form stable, "gummy-bear" implants pose problems for naturally small breasts?

Doctor Answers 8

Small (36A), pointy breasts. Are above the muscle, "gummy-bear" implants ideal?

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement.

Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.

Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.

Hope that this helps! Best wishes for a wonderful result!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

Can size A cup breasts be augmented above the muscle?

It is possible to place implants above the muscle in your size breasts. The implant choice can be a standard cohesive gel and does not require the gummy bear. But it does require an in person consultation to determine whether you have enough breast tissue to camouflage the implants above the muscle.

David A. Ross, MD (retired)
Chicago Plastic Surgeon
4.6 out of 5 stars 89 reviews

Gummy implants

The gummy implant is a an excellent device. It can be placed both above and below the muscle. I recommend you researching your risks prior to having the implants placed. One of the most common complications with augmentation is capsular contracture, by placing the implants  above the muscle you increase this risk. Capsular contracture is correctable, but the literature states that recurrence of the contracture is as high as 22%. I recommend speaking to a board certified plastic surgeon on the pros and cons of placement. Ask to see what a contracture looks like so you understand the complication.

Johnny Shea-Yuan Chung, MD, FACS
Allentown Plastic Surgeon
4.3 out of 5 stars 19 reviews

The "ideal" implants for you...

There are several factors that plastic surgeons consider when recommending implant sizes. 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

Small (36A), pointy breasts. Are above the muscle, "gummy-bear" implants ideal?

Women with very little of their own breast tissue are the best candidates for form stable tear drop shape implants above the muscle. This is the best usage for this product. 

Breast implant placement for pointy breasts

Thank you for your question.  There are many advantages to having your implants beneath the chest muscle most importantly less risk of capsular contracture.  There is also less chance of visibility in patients who have little breast tissue.

In my opinion placing the implants under the muscle will naturally cause the shape of the pointy breast to become more natural looking.  Unless you have a true tuberous breasts, placing the form stable implant beneath the muscle should improve breast shape and size.

Gummy bear implants above the muscle.

Dear GG,
thank you for your post.  No, the gummy bear implants are ideal in the above the muscle position.  They are naturally tear drop shaped and have the least amount of rippling.  Most of my patients prefer this position and are very happy with their results.
Best Wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

Gummy Bear

There are many, many opinions about the question you have asked. Pictures wound be needed to give you a more exact recommendation... but unless you are a "workout freak" I would prefer to place the form stable implant below the muscle. The pectoralis will add additional soft tissue coverage if you are thin. In general, the capsular contracture rate is lower in the subpectoral position. If you did have any rotation of the implant...it may be less noticeable under the muscle due to the additional muscle coverage. ...those are my thoughts. Hope this helps.

  

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.