Under vs over for a fitness instructor
Since going under the muscle adds "padding" over an implant to the upper half of the breast but doesn't really add support from the bottom, over is often a good choice for athletic women if there is enough tissue coverage. There are hybrid procedures such as subfascial and split submuscular that may be worth considering for thinner women who are active. I would add just one comment though, 450 cc for someone who is already a D cup is not a typical choice for women who are physically active - it seems on the large side.
Should Breast Implant Placement Matter when It Comes to Support?
When Implants are placed under the muscle, it is my impression that this offers greater support for the implant. In some instances this results in a greater tendency of the "Snoopy breast". On the other hand placement over the muscle, generally provides less support and an increased likelihood of the "rock in the sock" deformity. However, these are gross generalizations.
Implant placement is often a plastic surgeon's choice
Whether an implant is placed above or below the muscle is decided upon between the patient and plastic surgeon. I rarely place an implant above the muscle because I think the muscle coverage provides a more natural appearance and leads to better coverage in the future.
As an aside, I am not a fan of cresent lifts but this is also my personal preference. This procedure should be reserved for a woman who has minimal sagginess (ptosis).
Your plastic surgeon will most likely tell you to wear a very supportive bra as you heal and then when you return to work as a fitness instructor.
Best of luck to you.
Placement of breast implants under the muscle helps to support breast long term
I disagree with your doctor! Placing the breast implant under the muscle gives them much better long term support. In fact, I have offen seen rapid sagging of breasts when a large implant is placed over the muscle, irregardless of breast size.
One of the reasons that you doctor might have recommended subglandular placement is that, in that case he does not have to perform a more extensive breast lift, but the breast would not be lifted as much as they should have been.
POLE DANCER DEFORMITY byVillar
Over the muscle, under the muscle is a very complex issue. Every patient is different and must be evaluated case by case. A hands on thorough examination is critical in choosing the proper operation.
There is a lot of bad advice available. Beware of the inexperienced when you hear:
"Definitely gives the breast a more natural look if the implant is under the muscle."
" Under the muscle drastically decreases the risk of capsular contracture."
" Absolutely confident that the aesthetic outcome for these patients will be far superior with implants placed under the muscle.
"Placing the breast implant under the muscle gives them much better long term support."
"Gummy Bear implants are superior to silicone memory gel implants".
"if the implant is under the muscle mammograms - telling them you have implants will prompt them to take one extra view. With this extra view, the detection of cancer is the same as if you did not have implants."
There are patients who's activity and anatomy make them unsuitable for sub-muscular placement. (See Pole Dancer Deformity) They are better off having no implants at all, than placing implants under the muscle.
Patients who insist on having implants under the muscle for a better mammogram and have anatomy that will result in a cosmetically inferior result are advised; we will not trade an ugly breast in exchange for a better mammogram. The surgeon's job is to give you the most natural looking and feeling breast possible with the tissue he has to work with.
If your anatomy is not suitable for sub-muscular implants, and you want the best mammogram, DO NOT HAVE ANY IMPLANTS AT ALL FOR THE BEST MAMMOGRAM.
Best wishes. Knowledge is power Luis F. Villar MD FACS
Breast Implants for a Fitness Instructor
I regularly perform breast augmentation surgery for patients who participate in body building, fitness and figure competitions. While many are initially concerned about sub-pectoral placement and the potential for distortion of the appearance of augmented breasts when the pec major contracts, I am absolutely confident that the aesthetic outcome for these patients will be far superior with implants placed under the muscle.
A pre-pectoral implant in a slender patient, especially one with well-developed muscles, looks just as you imagine it would: like a foreign object, not like a natural-appearing breast. The muscle does not have to contract for a pre-pectoral implant to look unnatural in this group of patients - it looks unnatural every minute of the day.
Achieving the ideal aesthetic position for a sub-pectoral implant requires release of part of the inferior origin of the muscle from the chest wall. I perform the minimal release of the origin of the pec major that is required to get the implant in an ideal position vertically, but also weaken the origin in the area where muscle contraction tends to displace an implant. As a result the vast majority of patients have little to no distortion of their breast appearance when the pec major muscles are tensed. Patients also do not experience any loss of function, strength or range of motion from release of this very limited part of the pec major origin. Many patients have indicated that their natural (but augmented) breast appearance has provided a significant advantage for them in competitions.
I do not think one pocket location over another will affect the support. I think the quality of the skin and soft tissue as well as the size of the implants will matter more.
Breast Implant sizing and Augmentation
The placement of the implant has more to do with the amount of tissue coverage to disguise the implant versus the support for the implant. The larger the implant the more gravitational wieght and stretching of the tissues- the muscle will not stop this and particularly with a 450 cc implant which will only be partially covered by the muscle if placed underneath.
As a fitness instructor and being a 'D' cup- you may find the size of the implant slightly large- this would of course also depend on the degree of lift that is required.
The combination of a lift- which generally makes the breast look smaller and - an augmentation is a complicated procedure and does require a lot of finess.
With Warm Regards
Trevor M Born MD
1) 450 cc's much too big if you are now a D cup. You will have a very hard time as fitness instructor.
2) Over the muscle placement probably good.
Above or below the muscle for support
From the information you provide it may be appropriate to place the implant above the muscle. When implants are placed "under the muscle" they are really only partially covered by the pectoralis muscle. If you flex you pec and feel the lower edge you will notice the muscle doesn't extend to the lower outer portion of the breast. There really isn't any loss of support if the implant is placed above the muscle.
The reason that the large majority of saline devices are placed beneath the muscle is to provide as much tissue cover as possible to allow for a more natural result in the upper portion of the breast and to minimize the potential of palpability. Since there is no pectoral is muscle in the lower outer breast, in thin patients it is possible to see the edge of the implant. you sound like you have adequate thickness of breast tissue to cover the device. The reason your surgeon is recommending above the muscle is to minimize the possibility of movement of the breast with pectoralis contraction. This type of decision involves balancing the different trade-offs with the choice of "above or below".