In my opinion, you are a great candidate for transaxillary breast augmentation. Unfortunately, most surgeons do not perform this operation. You will have to ask specifically if your surgeon performs breast augmentation through the transaxillary approach. You do not want a surgeon performing an operation he or she does not feel comfortable with, or do regularly, and they won't. Scar location is one of the decisions you should consider, but overall qualifications and experience of the surgeon are more important.
It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.
Breast augmentation is all about a healthy conversation between patients and their surgeons. I would recommend finding a plastic surgeon that really listens and tries to understand what your goals are for a natural feel especially if you have already felt silicone and don't like them. Remember there are different companies that make different silicone implants and saline ones too. Anatomic versus round implants have long been debated and the recent American Society of Aesthetic Plastic Surgery this was heavily debated at the scientific session. The jury is not out on this question and the most important thing is making an informed decision and understanding the risks and benefits associated with any type of implant that can include things like rotation or contracture. Sometimes an implant can be placed from a transaxillary incision or incision made in the armpit area. A board certified plastic surgeon's office can have sample implants to help you visualize what the implants feel like Best of luck! MMT
Most surgeons choose a periareolar or inframammary incision because it gives the best direct access to perform the procedure.
If you wish to keep the scar off of the breast underarm approach to your breast augmentation is certainly possible. For a very natural look and shape a moderate profile silicone gel is a good place to start.
My over the internet pure GUESS! 350 cc moderate +. Axillary incision has a larger incision in arm pit, just be sure you understand that.
Thank you for your question and photographs. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend you voice your concerns with your surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations. It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like. In most cases an implant can be placed through an underarm approach but this discussion will depend to some degree on your surgeon's comfort level with this approach based on your desired appearance.
Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “very natural” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.
How to Pick the Right Size and Shape of Breast
One of the more frequent questions I'm asked as an aesthetic plastic
surgeon for patients considering breast implants is "how do I know what
size, and shape I need?” The answer
to this question has changed dramatically throughout the 25 years that I've
been doing breast augmentation. I've also learned that the words that patients
used to describe either what they want or don't want can be completely
misleading into what I interpret their meaning to be. Therefore, I like to
request that our patients considering breast augmentation bring in photos of
both what they think they like and what they don't like. There seems to be a
multitude of sources on the Internet where these photos can be downloaded. By
looking at the patient's desires, I get a better understanding of what they
want. We no longer recommend that we place the exact implant on top of the existing
breasts and then place a stretchy bra over it to give us any idea what that
exact same implant under the muscle would produce in size. That method, in my
opinion, will always over represent what the actual result will be. If you are
going to use a sizing type method, then Mentor makes a shell sizing system such
that, when the shell size corresponding to the implant that it represents is
placed over the existing breast and in a bra, it will better represent what
that size implant under the breast and muscle will look like. We've also used
3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this
method, a three-dimensional photograph of the actual patient is taken and can
be seen on a large screen television by both the physician and perspective
breast augmentation patient at the same time. We then can place all of the
different implants that are available under that image and decide what size,
shape, fill ratio, and height to base width relationships will look best for
each patient. Silicone gel breast implants come basically into shapes either
round or shaped. They also come with either a textured or smooth surface. In my
mind, there are advantages and disadvantages of every scenario and combination
of those choices. Most of the time a round smooth implant placed under the
muscle works very well for breast augmentation patients. It's then very simple
to just look at size and ratio projection to base width and select the perfect
implant for that patients shape and desire. Sometimes we would like to use a
textured surface implant. Here the advantages are that the textured surface
implants tend to migrate less in the pocket, as there is some frictional
resistance to motion. Another advantage of textured implants is that the
capsular contracture rate, especially when implants put above the muscle, is
less than for smooth wall implants. Shaped implants, because we do not want
them to turn in the pocket, are always textured. My planning method to optimize
the best implant for each patient is begun with a measurement of the base width
of the breast. We would then like to subtract about a centimeter and a half
total off of that number so as to have coverage of breast tissue over the
implant. We then will have a range of implants whose base width matches that
number. If we go larger than that number, which sometimes patients will want,
we as plastic surgeons know that these larger implants can have more problems
down the line. For instance, larger implants may migrate below the crease which
one has to lower at the time of surgery in order to get the implant in. When
these implants migrate below the natural crease, they can create a second
crease in what we call a "double bubble". Large implants can also;
because of the pressure they put on the overlying breast tissue, thin that
tissue out such that there is less overlying breast tissue over the implant as
time passes. After we have the base width, our next decision needs to be what
is the ratio of the base width to the projection of the implant. Essentially,
there are usually four choices ranging from fairly flat which is called
low-profile, to progressively more height and less width with the same volume
of silicone gel, which is called ultrahigh profile. There are two profiles in
between which are the ones more commonly used and these are called moderate
profile and moderate profile plus. Common scenarios in which taller implants
would be desired may be in patients who want a larger look than their natural
base with would allow or have a fair amount of loose overlying skin that were
trying to hold up. For patients who want a more natural look, a moderate
profile or moderate profile plus shape is more desirable. There are also
anatomically shaped implants. Rather than being around these implants can
either be taller than they are wide or wider than they are tall. There are good
reasons in patients to use either. For instance, in the patient's with very
widely spaced breasts and a large breastbone, a shaped implant that's wider
than it is tall can help hide that a little bit. Another example of the patient
in who a shaped implant would be best, is that patient with laxity after
childbirth or weight loss. When the nipple is just at the level of the
inframammary crease, we can sometimes get away with a tall implant that is
anatomically shaped such that the nipple when is it at the lower two thirds of
the breast mound created by the implant still looks good and natural and may
obviate the need for a breast lift. By spending some time, long before the
operation takes place, using the Vectra® 3-D imaging method, we can decide what
type, shape, and ratio of width to height would best serve the patient's needs.
We can then avoid what is sometimes done which is the placement of sizers at
the time of surgery. These sizers, in my opinion, have a few negative
implications. One is that there is a cost inherent in using them and usually
multiple ones are needed to make a decision as to which implant would look
best. I also believe that placing sizers in and out of the breast pocket can be
traumatic to that pocket and can cause bleeding. For me, the state-of-the-art
in today's breast augmentation is to decide long before the operation exactly
which implant would look best using computer animation. A new wrinkle into the
choice of breast implants is that breast implants now come with silicone gel
that is filled to a higher volume in the shell where it is placed. This will
allow for a round smooth implant, for instance to collapse less in the upright
position mimicking more of the look of the shaped implant. When patients show
me a photo of a very rounded upper part her breast, I would likely choose one
of these higher volumes implants such as the Natrelle Inspira® silicone gel
breast implant. Often times patients will present with breasts that are of
different sizes. One of the options to correct this is to use breast implants
of different sizes in order to best create symmetry. One of the newer methods
to help in symmetry creation is to do what we call a hybrid breast
augmentation. In the hybrid breast augmentation, the patient who has asymmetry
of the breast to begin can have matching silicone gel implants placed and the
overlying breast tissue can be made to look the same in volume and shape by
using fat grafting. In that way, no matter what the change in weight of the
patient is over time, the breast is more likely to have the same or similar
size. When it comes to symmetry, I like to tell our patients that they should
consider their breasts to be sisters that live across the railroad tracks from
each other rather than twins. In the past, when using saline implants, I did a fair number of press augmentations through the underarm approach. With the stiffer silicone gel implants that exist today, I would find it difficult to place that implant and position it without direct visualization. Therefore, more commonly either a crease or periarola incision is used. I have not found either of these incisions to be objectionable to my patients. With proper preoperative planning and flawless
execution of breast augmentation, this can be one of the most satisfying
aesthetic plastic surgery outcomes for both patients and physicians.