Would getting motiva ergonomix2 implants subfascial look very augmented on me? (Photos)

Question

Im planning for surgery in feb and jusy want other opinion before my consult. My goals are a very natural augmention, and not too big (currently 30b). I want to know if getting motiva ergo 2s subfascial would look very augmented. i want to avoid UTM because i really dislike animation, and i have wider set chest. Im comsdierimg fat transfer as well but worried that it wont stay. Just want to hear about expierence with moderate profile OTM implants on less body fat.

Donovan Rosas, MD · Answer

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular/Subfascial Augmentation (“overs”):

•	Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster 
when compared to subpectoral augmentation.

•	Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

•	Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

•	Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

•	Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

•	Subpectoral implants have a lower rate of capsular contracture.

•	Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

•	The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.

With regards to your specific question, subfascial augmentation in small breasted patient with little native tissue requires careful/conservative sizing to ensure that the implant is adequately camouflaged. This is not mean to discourage but rather to prepare you ahead of time re: volume/size limits.

As always, your board certified plastic surgeon can help guide you in your decision making process.

Daniel Barrett, MD · Answer

Dear Cute248365,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Arthur Dean Jabs, MD, PhD, FACS · Answer

The pendulum for augs swings back and forth regarding placement. It has been my experience that disrupting the breast to muscle ligaments in a thin women like yourself and placing the implants sub glandular/fascial leads to implants that can later sag and are more visible in the upper pole. If you went with small implants you may do better. If you want to go large I would ask you consider going under the muscle.

Best of Luck

Dr. Jabs

Best of Luck

Dr. Jabs

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there &mdash; your goals are very realistic, and based on what you described, you’re actually a great candidate for a natural-looking augmentation without going too big.
Will Motiva Ergonomix² look “augmented” in a slim patient?
Not necessarily. Ergonomix² doesn’t behave like a traditional round implant.It naturally shifts between a round and teardrop-like shape depending on posture, so it avoids the “stuck-on, ball-like” look many patients fear.
Even in very slim patients with low breast tissue, it still settles softly and naturally.
Is a Demi profile too much?
No &mdash; Demi does NOT create an augmented look when paired with Ergonomix².Demi is essentially a moderate projection, and on a narrow chest it provides gentle fullness without looking artificial.
About subfascial (OTM) placement
Subfascial placement works extremely well with Ergonomix² &mdash; especially if you want to avoid animation deformity.This is actually the approach we commonly use even in mastectomy patients (who have zero natural breast tissue), and it still gives a smooth, natural contour.So on a naturally slim patient, it is absolutely appropriate.
Fat transfer?
It can help with softening or mild contour enhancement but will not reliably replace an implant unless your volume goals are very small. Some resorption is expected.
✔ Ergonomix² does not look overly augmented, even in low body fat or small-breasted patients✔ Demi projection is safe for a natural result &mdash; not too big, not too round✔ Subfascial placement avoids animation and works well on a wide-set chest✔ Fat transfer can complement, but won’t fully replace implants for noticeable fullness
Your plan is very much aligned with achieving a soft, natural, non-augmented look.

Jeffrey Lisiecki, MD · Answer

Subfascial breast augmentation when done properly gives a very natural upper pole, more like UTM implants than the other OTM techniques.  I do mostly subfascial augmentation and most of my patients are lean and athletic without a lot of natural breast tissue, and have gotten very natural-looking results doing so (without fat grafting).

Tyler Frew, MD · Answer

Hi there,
In the beginning, like right after your surgery, yes they will look more fake than they will once they have stretched the skin and settled. ATM settles and shapes differently than UTM. I think your implant profile and filling are appropriate for your goals. 
I would personally add on the fat just to soften the transition zones and the medial cleavage where the skin is thin
All the best

Brian K. Reedy, MD · Answer

Thanks for your question! I do think the ergo will look very nice on you. I don't think the fat grafting should be necessary as you appear to have a nice pad of breast tissue. Best of luck!

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for over 30 years and revisionary breast surgery is a large portion of my practice.  When considering breast augmentation above or below the muscle, it is the lesser of two evils.  Usually, the animation deformity from breast augmentation is minimal, however when you place implants on top of the muscle, the complications are significantly worse - slide down and wrinkling. I have a whole gallery of patient's with long-term changes with implants on top of the muscle.  If you look at the fascia of the pectoralis major muscle, it is about the thickness of tissue paper.  It is a fallacy that there is any strength in the fascia of the pectoralis major muscle.  In reality, subfascial IS subglandular. You should be able to have an excellent result.  Best wishes to you.

Vasileios Vasilakis, MD, FACS · Answer

Hello,
Thank you for the question. It is hard to tell from this photo, but it seems that a small Motiva ergo in the subfascial position will be appropriate and will meet your goals. 
I wish you the best. 
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

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