I am currently a 34 B/C with mild drooping and am getting 345 cc moderate profile implants. I am anxious because my doctor wants to do over the muscle to correct drooping. I have read that over the muscle has increased risks and is more problematic in the long run. I want to have fullness in the upper portion which is why he suggested over muscle but now I am wondering if I could achieve the look I want with going under the muscle?
January 29, 2017
Answer: To go under the muscle or above the muscle? Your photos are not the best, but they suggest that you may have some degree of glandular ptosis (drooping or pseudoptosis) which is a condition where the breast gland is sagging, but the nipple is a separate issue. In my (humble?) opinion, I do not believe there is an indication in a primary (first time) breast augmentation to place an implant above the muscle. While this may make some of my colleagues cringe a bit, it is an opinion and nothing more. Using a technique called a "dual plane" placement, first described by Dr. John Tebbetts, a breast pocket is created that is below the muscle, but has some of the benefits of a pocket above the muscle, including better ability to deal with glandular ptosis. I would strongly suggest that you get an opinion from a surgeon familiar with the technique, as I believe, as best I can tell from your photos, that you are a very good candidate for this.
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January 29, 2017
Answer: To go under the muscle or above the muscle? Your photos are not the best, but they suggest that you may have some degree of glandular ptosis (drooping or pseudoptosis) which is a condition where the breast gland is sagging, but the nipple is a separate issue. In my (humble?) opinion, I do not believe there is an indication in a primary (first time) breast augmentation to place an implant above the muscle. While this may make some of my colleagues cringe a bit, it is an opinion and nothing more. Using a technique called a "dual plane" placement, first described by Dr. John Tebbetts, a breast pocket is created that is below the muscle, but has some of the benefits of a pocket above the muscle, including better ability to deal with glandular ptosis. I would strongly suggest that you get an opinion from a surgeon familiar with the technique, as I believe, as best I can tell from your photos, that you are a very good candidate for this.
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January 29, 2017
Answer: Good question. The advantages of placing the implant ABOVE the muscle are that this mimics the natural breast, since there is no breast tissue below the muscle anatomically. There are four reasons implants are placed under the muscle:1. There is the theoretical advantage of reducing the risk of capsular contracture (hardening, distortion, and possibly pain).2. You eliminate the possibility of "animation deformity", the movement or "twitching" of the breast when you activate your pectoral muscle.3. The muscle does provide some coverage or camouflage of the round implant thus creating more of a tear drop appearance to your implant as it sits beneath your breast. 4. Mammograms are a bit easier to interpret when the implant is under the muscle. As several of my colleagues have suggested, your own breast tissue needs to be adequate enough to cover your implant if it is place above the muscle, and a more natural appearance is likely to be obtained if a lower profile implant is selected when placed above the muscle. The higher profile implants have a risk of looking artificially round and proud, not what you think of as a "natural" appearance.Discuss all of this with your plastic surgeon. If you are not confident, do not be reluctant to seek a second opinion. Make sure that your sense of aesthetics aligns with that of your plastic surgeon's based on this or her before and after gallery of photos. The implant you have theoretically selected is relatively conservative in size, and that is consistent with a more natural appearance, but any opinion on REALSELF regarding your specific treatment plan or implant size should not be considered as valid as one that is arrived at after an evaluation in person. Based on your photos, however, if the decision is made to place the implant below the muscle, it will need to most likely be "dual plane", meaning that it is kind of a compromise between the two techniques, and one that make the implant position more "suglandular" that a straightforward "sub pectoral". Best of luck to you.
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January 29, 2017
Answer: Good question. The advantages of placing the implant ABOVE the muscle are that this mimics the natural breast, since there is no breast tissue below the muscle anatomically. There are four reasons implants are placed under the muscle:1. There is the theoretical advantage of reducing the risk of capsular contracture (hardening, distortion, and possibly pain).2. You eliminate the possibility of "animation deformity", the movement or "twitching" of the breast when you activate your pectoral muscle.3. The muscle does provide some coverage or camouflage of the round implant thus creating more of a tear drop appearance to your implant as it sits beneath your breast. 4. Mammograms are a bit easier to interpret when the implant is under the muscle. As several of my colleagues have suggested, your own breast tissue needs to be adequate enough to cover your implant if it is place above the muscle, and a more natural appearance is likely to be obtained if a lower profile implant is selected when placed above the muscle. The higher profile implants have a risk of looking artificially round and proud, not what you think of as a "natural" appearance.Discuss all of this with your plastic surgeon. If you are not confident, do not be reluctant to seek a second opinion. Make sure that your sense of aesthetics aligns with that of your plastic surgeon's based on this or her before and after gallery of photos. The implant you have theoretically selected is relatively conservative in size, and that is consistent with a more natural appearance, but any opinion on REALSELF regarding your specific treatment plan or implant size should not be considered as valid as one that is arrived at after an evaluation in person. Based on your photos, however, if the decision is made to place the implant below the muscle, it will need to most likely be "dual plane", meaning that it is kind of a compromise between the two techniques, and one that make the implant position more "suglandular" that a straightforward "sub pectoral". Best of luck to you.
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