Will 225 and 275cc subglandular, high profile implants give me a natural look? (Photos)

Question

I went to a surgeon on Tuesday and I was hoping to go under the muscle because I heard it was more natural, but my surgeon disagreed and he said he won’t do it under the muscle as it will exaggerate the dip in chest wall. He said over the muscle will be more natural. I am confused because I thought under the muscle was more natural. I don’t want it to look like I’ve two tennis balls under my skin and want it to look like I haven’t had an augmentation. I am 5'0 and 100 lbs.

Vasileios Vasilakis, MD, FACS · Answer

Hello and thank you for your question. Based on photographs, under the muscle is likely the safest option, and the one that will give you the most natural results. In-person examination is extremely important, therefore I cannot say this with certainty. I recommend that you have consultations with other surgeons as well prior to committing to a surgical plan. I wish you the best of luck. Vasileios Vasilakis, MD. Fellowship-trained plastic surgeon.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Based on your pictures, and the apparent amount of breast tissue you apparently have, I would recommend placement of the implant below your muscle.

Daniel Barrett, MD · Answer

Dear Lexi Reid,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ram Kalus, MD, FACS · Answer

Your surgeon obviously had the advantage of examining you, but in general, I agree with your impression that a more natural outcome tends to be achieved when the implant is placed under the muscle, thus achieving a slight upper pole flattening and therefore mimicking the natural breast. It is impossible to know ahead of time if you need a 50 cc difference or less or more, but it is important to realize that fine tuning your asymmetry can only be achieved using a saline filled implant. That said, it is generally agreed upon that our eye can rarely distinguish differences of less than 20 cc's in breast size. And as you probably well know, chest wall asymmetry such as you appear to have, is extremely common.

If you have doubts or concerns after your initial consultation you might be advised to see a second opinion. It is important to also keep in mind that a subtle asymmetry is likely to persist even with the optimal breast augmentation. I recommend using photos of your "ideal" outcome to share with your plastic surgeon to make sure you are both looking at the same picture. Words such as "natural" can mean different things to different people. Best of luck to you.

Donald R. Revis Jr, MD · Answer

Good morning,
I totally disagree with your PS- your implants should be placed under the muscle- they will look better, last longer, have a lower rate of capsular contracture, and mammograms will be better.

Connie Hiers, MD, FACS · Answer

With minimal breast tissue, I would recommend placing the implants behind the muscle so the edge of the implants is not visible. For a more "natural" look, I would suggest the moderate plus profile instead of high. However, not everyone agrees on what is "natural."

Ali Gurlek, MD · Answer

Thank you for your Question. 
yes it will give you a natural look.there are multiple factors influencing the actual size increase a breast implant will provide other than volume, including:
Implant profile (projection) and base widthImplant shape (i.e., classic round, teardrop shaped, extra upper pole fullness)How much natural breast tissue you haveThe width and contour of your rib cage

Carlos Gonzalez Legarda, MD · Answer

Well, it is good be 100% clear: Breast with implants don´t look like the natural ones.  Most of the patients and surgeons find the shape of a breast with implants better and more attractive, but I insist that is not the natural tear drop of a natural breast.  Then having in mind implants any case will give you a more fullness upper pole, it is 100% true over the muscle the "natural" tear drop appearance can be less changed, but I insist any case the final appearance is not going to be "natural" (again, I think in fact it is better).
As many surgeons I also prefer to put an implant under the muscle, that is what I do for most patients, but that is not good for all patients. 
According your pictures, you are good candidate for under, over, or even dual plane.
 I'd put under the muscle preferable.

Johnson C. Lee, MD · Answer

I prefer to place the implants below the muscle for a natural slope and appearance unless you have a significant amount of breast tissue which does not seem the case. Some surgeons are more comfortable doing them one way or the other and therefore will promote one style more than the other. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Joseph Fata, MD (retired) · Answer

As you can see, opinions differ but both approaches are perfectly acceptable. I prefer under the muscle because there is more long-term support of the weight of the implant, contractures of the implant capsule and mammagrams are easier. If you truly have a depression of the bone between your ribs, leaving a layer of muscle intact along the inner boarder of each breast would counteract any tendency of the implants to drift towards the middle. Good luck.

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