Breast Enlargement After Having a Baby Which Would Be Better and More Natural Looking, Overs/Unders? (photo)

I recently had a baby 7 months ago, prior to my son my breasts where a large C cup, now they are an empty size c. I want a breast enlargement to fill out my breasts to what they were pre-baby. My breasts are still quite full at the bottom but flat and empty at the top. I have been for one consultation (got 2 more booked in) the first surgeon has suggested 210cc overs. What size/shape/profile do you think would be best to make me back to a big C cup looking natural with slight lift if possible.

Doctor Answers 9

Breast Implant Position

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are a number of compelling reasons for selecting subpectoral placement over submammary placement. The most significant is that fact that radiologists have indicated that it is easier to image breast tissue by means of mammography when the implant is subpectoral. The pec major also provides an additional layer of tissue to conceal breast implants in the 'social aspect' of the breasts - that part that is easily visible in swimsuits and lower-cut clothing. Additionally, the pec major is quite effective at flattening the upper pole of a breast implant so that a natural slope for the upper aspect of the breast is created.

Implants placed on top of the pec major tend to look very convex in the upper pole. The breast begins quite 'abruptly' in the upper aspect of the chest, and the appearance is therefore distinctly unnatural. Submammary implants are also more likely to have visible implant folds and ripples in the cleavage area. Another consideration is the fact that there is some evidence which suggests that the risk of capsular contracture may be lower with subpectoral implant placement. Even if the risk of contracture is the same, a mild contracture tends to be less noticeable and therefore less of a problem for the patient when the implants are in a subpectoral position.

Submammary placement may produce a reasonable result for fuller figured patients with larger starting breast volumes, as the larger amount of natural subcutaneous fat and breast tissue helps to conceal the implant contours. The problem is that as breasts age, they tend to deflate - especially in the upper pole. So what was adequate implant coverage in the cleavage area at age 27 may be inadequate coverage at age 37, and implant folds and ripples gradually become visible. So subpectoral placement is the best choice for both the short and long term. 

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Just based on your photo, your nipples lie below the IMF but not at the lowest part of the breast which means you have grade 2 ptosis plus it looks like you have a long chest. Unless you want to tuck your implants into your wasteband, I suggest you have a mastopexy. Good luck!

Breast implant choice after pregnancy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would check to see where your inframammary crease falls in relation to the nipple level and if it is not too high relative to the nipple, then an augmentation alone should be able to achieve your goals. Many years of experience and proper technique both short term and long term indicate that breast implants should be below the pectoralis muscle which only covers the part of the implant from the nipple-areola up but pads and protects it and makes the result look natural both short term and long term. With your tissue coverage a saline-filled implant should do fine, but whether it's a saline-filled or silicone gel-filled implant, the minimum size increase and filling the upper pole is one cup size. This would be a low profile implant in saline-filled (Allergan) that is fitted to the width of your breast. In gel-filled implants this wouldn't be called a low-profile implant but would be the lowest profile available, also fitted to the width of your breast. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast Implants Over or Under

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You are experiencing typical changes after child birth.  Based on the pictures the sagging present would likely be alleviated with an augmentation alone.  A dual plane dissection would likely help  to overcome more of the sagging while filling out the upper pole.  The volume you are selecting is relatively low and therefore you would likely need a low profile implant which distributes more of the volume along the base.  This would allow for more uppr pole fullness.

Christopher J. Schaffer, MD
Birmingham Plastic Surgeon

Breast lift and implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Implant can be placed over or under the muscle.  It certainly looks like you have enough tissue to go above the muscle. You possibly need a lift as well.  An exam in person is helpful.

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

Not Just a Question of Over or Under

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for the photos.  You current have described your situation correctly.  You have ptosis (sagging).  Placement of an implant under the muscle will more than likely produce a Snoopy deformity while placing it over the muscle will require such a large implant that it will put to much pressure on the skin over time and continue to stretch the skin= more sagging.  Get your two other consults complete.  Your particular case would be best treated with an augmentation and a lift.  

Dr. ES

Implants Will Not Correct Sagging

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I feel that patients almost always get a more natural result when implants are placed under the muscle.  It appears from your photos that you have nipples which are located beneath the inframammary fold.  If so, you are likely going to need a lift as well.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Subglandular placement of breast implants?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question.

Unfortunately,  it is not possible to give you precise advice without direct examination and a full communication of your goals.  Based on the pictures alone,  I am not convinced that breast augmentation surgery alone will provide you with a aesthetically pleasing results; breast lifting may be necessary to do so. 

 Generally speaking, I would for these sub muscular (dual plane)  positioning of breast implants;  there are many advantages of placing implants in this position.

In regards to breast implant selection I would suggest that you:

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're 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 if communication will be critical in determining which operation and/or 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. I have found that the use of words such as “natural”  etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

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.

I hope this helps.


Over or under the muscle 7 months after having a baby?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You appear to have ample breast, so regarding size, you need to visit your plastic surgeon and place sizers inside your bra followed by a T-shirt. See what you like and go with it. Bras are not well standardized, so you may be a C in one brand and a D or different size in another. If you are trying to only fill out the top of your breast, then a 210 cc may be fine. That is a small implant, however.

Regarding under or over the muscle, either would look fine. I have spent decades placing them both on top and behind the muscle and still do either according to the problem. If you have very little breast, not your case, I put them under the muscle. Otherwise, it makes no difference in my opinion. If they encapsulate and become hard, they will look better under the muscle. However, if they stay soft and moveable, on top looks a little more natural.

Implants can be place closer together on top of the muscle, and the implants don't distort when the pectoralis muscle contracts, which happens to many placed under the muscle.

The best bet is to discuss this with the plastic surgeon that you feel most comfortable with, and go with his opinion. I doubt if you can go wrong with either under or over providing you get a size that you like. Good luck with your surgery.

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.