I'm a small 34 B and I'm thinking about getting 375 cc gummy bear tear drop shape implants. Will this give me unders? (photo)

You have small breasts with short inframammary crease-to-nipple distances. Nipple position appears to be above the crease on each side, however, and both point forward instead of down. You DO have mild ptosis (breast droop or sag), but I would not characterize this as "grey zone" or borderline requiring a lift. Implants alone will likely provide a nice breast augmentation, especially as the implants drop and tissues stretch . . .. . . but not with textured implants, which do not drop.Implant position above or below the muscles is not determined by implant type, OR degree of ptosis. Some plastic surgeons will place implants above the muscles to try to correct minor degrees of ptosis, but doing so increases risk of capsular contracture, AND increases potential visibility of implant ripples or edges (especially with saline, which fortunately you are not choosing). Textured implants above the muscles can help reduce the incidence of capsular contracture compared to smooth implant above the muscles, but going below the muscles reduces CC more (regardless of surface texture or not), as well as visibility of implant ripples or edges.Shaped (teardrop or so-called "anatomic") implants will provide a nice sloping shape when standing upright. So do smooth round implants, which are teardrop-shaped when the patient is standing. But textured teardrop-shaped implants remain that shape when reclining, which is decidedly unnatural and non-anatomic. Smooth round implants flatten and round out when you are reclining, as well as drop slightly to the side of the chest, just like naturally-larger breasts, making smooth round implants actually MORE "anatomic" than teardrop-shaped implants.You don't need shaped implants to have under the muscle placement. You need a surgeon who, like the majority of plastic surgeons, understand that submuscular placement will give the lowest risk of CC, the least visibility of ripples or implant edges, nice slope in the upper poles, and with proper size and smooth implants, plenty of fullness in your lower poles as the implants drop into their final position. Again, textured implants do not drop--the textured surface keeps them where they are placed--over time the tissues soften and the breasts feel more natural, but the shape is determined by implant placement, making this more surgeon-dependent.There is nothing wrong with the use of textured implants--they are fine implants that are more costly, require a slightly larger incision, are rotationally (placement) sensitive, do not look natural when reclining, and feel slightly firmer (than smooth round cohesive silicone gel implants). Which of those do you like?I would suggest Sientra smooth, round, cohesive silicone gel implants placed via a small inframammary (crease) incision into a (dual-plane) submuscular position. This should give you an excellent result that achieves all your goals (including lower cost). For more information click on the web reference link below for my Comprehensive Guide to Breast Augmentation. There is a whole section on choosing implants, above or below the muscle, and smooth or textured. Best wishes! Dr. Tholen

 It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below. Smooth vs Textured implants will depend in part on your exam but note that textured implants have less chance of capsular contracture and breast massage is not needed.

Breast implants help provide fullness and volume to the breast. Shape can be improved with high profile and anatomic breast implants if placed in the right patient. An anatomic or tear drop implant can provide a very natural shape to a small chested patient. Anatomic implants and large volume implants do not lift the breast. Identifying breast ptosis and congenital constriction is important in the pre-operative analysis because this can be corrected with a mastopexy (breast lift) and breast implant. In a breast with inner constriction, this will need to be released to accept and position an implant.