Which Breast Implant Placement Should I Choose?

I've consulted two surgeons and each one has given me a different opinion on implant placement. I am currently a 34B and would like to achieve a full 34C or small 34D. I have stretch marks on my breasts and a small amount of loose/thin skin. I will most likely be getting a lift in conjunction with the implant. Which implant placement would help me achieve the look I want (lifted with a little more fullness on top, but with a gradual, natural slope). Also, would a lift without a vertical scar be sufficient?

Doctor Answers 11

Breast Enhancement without Lift

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Hi there-

Based on the photo you posted, I actually think you could achieve a very nice outcome (natural fulness with a more long lasting result) placing implants under your muscle without any lift at all.

This would require an advanced technique, but it is possible if you find a surgeon experienced in it.

You can find a good example of this technique here:

Implant and lift recommendations

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I prefer to place implants under the muscle( biplanar) aproach to give it more soft tissue coverage. You can probably achieve the lfit you want with a simple circumareolar procedure. I do them all the time.

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

Implant placement

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I would suggest plaving the implabt under the muscle.  Every surgeon has his or her opinion on this based upon their own aesthetic judgment and personal experience, but many of us find that staying under the muscle provides better camouflage and coverage to the implant in the long term.  Good luck, /nsn.

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Best Long Term result is Under the Muscle

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With regards to your situation, your best bet would be to go under the muscle.  It is a myth that you have to go on top of the muscle to better fill out the skin/ breast tissue.  If done correctly, under the muscle will achieve the same effect.  The problem with over the muscle is that over time, the implants have a tendency to pull more on the breast tissue, stretching the tissues out and sagging more.  Under the muscle helps hold the implant higher over time.  Also, going on top of the muscle makes it a little more difficult to read mammograms, and the rate of capsular contracture is higher.  With regards to the lift, it would just depend on the size of the implant used.  You may not need one at all, or you may just need a periareolar lift.  It is hard to really say until the implants are in position.  That is what then determines how much lift you may or may not need.

Subglandular implant placement when having lift at same time

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There is always a difference of opinion on this matter.  I prefer to place the implant on top of the muscle when performing a lift at the same time, as long as the patient has enough breast tissue to camaflouge the implant, which you do.  I do think you will have a prettier result if you do a lift at the same time; you can get away without one but the result will be prettier with one and will also allow you to use a smaller implant.  I strongly urge you to consider using the smallest implant possible to get the result you want and not to have a D cup as your goal.  Over time your results will hold up better with the smaller implant.  Hope this helps.

Tracy M. Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Implant placement

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Under the muscle using high profile implant. If not happy than at 3 months a donut lift under local anesthesia.


Implants over or under for sagging

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The common wisdom is that implants over the muscle may work best to corrrect a little bit of sagging if there is enough tissue to cover them. However, thinking long-term, the implants are likely to drop a bit and can lead to what is called a 'rock in a sock" look especially if they are large, as for instance what you would need for a D cup. So my preference is to go under and help the patient choose an implant size that is what they want, independent of what might be needed to avoid the lift; we then see how much of a lift if any is needed during surgery after the implants are in. Very often this can be something simple like a cresent lift. But implants over may lead to more problems later on if a lift is needed after further sagging.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Place breast implants over muscle to correct sagging.

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1)  You have easy anatomy.  It is possible that the right breast implants over the muscle will give you all the lift you need.

2)  If you do need a breast lift, I would think from your picture that you only need a "doughnut" lift with scars just around the nipples.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breasts can maintain a natural look after augmentation

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it appears as though you may get a nice lift with just the implants if you go for the D cup.  Otherwise, you may need a lift that just goes around the areola.  For implant placement, with a B cup to begin with you have the option of going over the muscle as your breast tissue will hide the implants nicely.  Over time, the implants will settle giving you a very natural look

Under the Muscle, Silicone Gel Implant with a Lift would give THE best Result

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From your photo graph you appear to have a significant curvature of your back (Scoliosis) which not only shifts your belly button to the right but also affects your chest wall as well. Your Left breast is larger and saggier than your right and both areolas are somewhat stretched out.

To obtain the dimensions you want would require a mid to large implant. Since gel implants are lighter and ripple less than saline filled implants I would recommend one of them to you. A Breast Lift would also have to be done. I doubt you would benefit from an around the areola only (periareolar) lift which would result in flattening of the breast and gathering around the areola. A lollipop scar lift is likely to be your best option.

Peter A. Aldea, MD
Memphis Plastic Surgeon

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.