Is 500cc subglandular the right choice? (Photo)

Question

Hello, I'm 39. 5'6" 137 lbs. Breastfed 2 kids? I am very active, I weight lift and play hard physical contact sports. I want to go from a 34B to a D-DD. PS recommend 415. Subglandular. I liked the 500cc in the seizers tho. I'm just afraid of subglandular in respect to capsule contraction and bottoming out. I also don't want my boobs to look funny when I move. So my question is: Is 500cc subglandular the right choice. Thank you for taking the time to answer my question.

Thomas S. Taylor, FACS · Answer

Given the look and size of your natural breasts you will have a good aesthetic result with your implants placed above or below the muscle. There are many advantages to placing implants under the muscle such as less capsular contracture risk, less implant palpability, and a more natural looking upper pole of your breast.  However, given the adequate volume of your natural breasts and the fact you are physically very active and enjoy weightlifting it is reasonable to place your implants over the muscle.  If you choose this option I would strongly recommend a silicone implant and one smaller than 500 cc for a more natural, less round result and to minimize the weight stress of larger implants.  I hope this information helps!Thomas Taylor, MD, FACSPasadena, CA

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements.  Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant
should be equal to or, more ideally, smaller than the width of your breast. The
breast width is a measurement of how wide your breast is at the base, which
should be measured at the level of the nipple. Choosing an implant that is
smaller in diameter than your breast width will avoid the "side
breast" fullness that is often associated with a more artificial
appearance.  Other than that, you should choose the implant based on
volume, not on the dimensions of the implant.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid silicone
(less cross-linked), if this implant should rupture, it will leak only into the
scar capsule formed around the implant but may cause some discomfort or implant
distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Ronald J. Edelson, MD · Answer

If you are athletic, I think the 500 cc implants you will find to be much too large.  If you really want to minimize the risk of capsular contracture you should go with sal e implants inder the muscle.  They rarely encapsulate.

Peter D. Geldner, MD · Answer

If your surgeon is recommending cohesive (or highly cohesive) shaped gel implants, subglandular may be a good choice. The issues you raise, specifically high activity and weight lifting as activities which could be adversely affected by submuscular placement, are quite valid. The shaped gel implants have much less rippling and retain a god appearance over the years. Your activities should return to normal quite quickly with little muscle weakness. As long as you have enough breast tissue to hide the edges of the implant, you should do well. Please remember that the determinants to good shaped implant selection are based more on the dimensions of the native breast than on the volume alone. These textured implants have shown a consistently lower rate of contracture than the smooth ones. Unfortunately, that rate is not zero. Best of luck.

Gerald Minniti, MD, FACS · Answer

Hello,Trust your intuition, place the implant under the muscle through an inframammary incision, close the pocket, and perform what you really need, a breast lift.  Too many patient who go the other route end up dissatisfied and ultimately get the breast lift and exchange of implants to the subpectoral position.Best of luck!

Farbod Esmailian, MD · Answer

Subglandular vs Submuscular is an important decision and one that your plastic surgeon should be able to make with your help.  The only issue with submuscular implant placement is that in patients that use their pectoralis frequently, they will notice animation deformity where the implant will move when the muscle is activated, but it will return to normal once relaxed.  There are many problems with subglandular implants and most advise against it.  You can have a very natural looking result with submuscular implant placement by performing dual plane technique.As far as implant sizing, that is something you should discuss with your plastic surgeon and go by the advice of your surgeon.  Going too big for your body will cause issues for you in the future.Good luck.

Stuart A. Linder, MD, FACS · Answer

I do not favor subglandular position because of increased risk of capsular contracture. Also, consider going with smaller implant to reduce future sagging and skin laxity

William Andrade, MD · Answer

Hello, it sounds like you are considering implants that are significantly larger than your PS recommended.  You are correct that larger implants do have increased risks like bottoming out, rippling, palpability, etc.  You also mentioned that you are very active and don't want the implants to be an issue.  These are all important factors to consider when choosing your implants rather than just the implant volume.  If you still have questions about your implant choice I would recommend having another discussion with your doctor.

Jed H. Horowitz, MD, FACS · Answer

This decision is really a personal choice. In general, for best aesthetic results submuscular placement is best as it provides a nice upper pole cover over the implant and helps it appear more natural. Particularly in your case where you have had 2 children and are lacking upper pole breast tissue the submuscular placement would probably be best. However, you are very physical active and may find the submuscular placement to compromise your weight lifting ability as you do lose some of your pectoralis torque strength. This is a choice that is best made by you depending on your goals. #PlasticSurgery #BreastAug #Implant #BreastImplants #Choosingimplants #recovery #salineimplants #siliconeimplants #submuscular #subglandular

Robert Singer, MD · Answer

The best cosmetic result in any
particular breast augmentation patient depends on a variety of factors,
including: Your individual anatomy, realistic expectations, a thorough
discussion with the plastic surgeon about the options, and an understanding of
the pros and cons of any particular implant choice. Proper sizing is not just
about the number of cc’s. The thickness of your tissue, breast dimensions which include the width, height, and projection, as
well as chest wall width all need to be considered when choosing an implant.
Trying on implant “sizers” of various shapes and volumes while wearing a tight
t-shirt, bra, or bathing sit at a preoperative visit will help you and your
surgeon choose the optimal implant.

There are no manufacturers' standards for cup sizing in the bra
industry. The cups of a 34 D-DD and a 38 D-DD are significantly different. Cup size
varies from manufacturer to manufacturer and even within styles from any
particular manufacturer. Nor is there a direct correlation between implant
shape or size and cup size.

Keep in mind that following the advice from a surgeon on this or
any other website who proposes to tell you exactly what to do without examining
you, physically feeling the tissue, assessing your desired outcome, taking a
full medical history, and discussing the pros and cons of each operative
procedure would not be in your best interest. I would suggest that your plastic
surgeon be certified by the American Board of Plastic Surgery and ideally a
member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you
trust and are comfortable with. You should discuss your concerns with that
surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Is 500cc subglandular the right choice? (Photo)

Answers (16)

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