Do you really "lose" 10% when placing round silicone implants under the muscle? (I.e. Natrelle Inspira) (photos)

I've heard that you lose 10% when placing the implant under the muscle, and should therefore choose a size you like THEN add the 10% in order to get the final cc amount. Is this correct? I.e.- I want a final outcome of around 375cc, so I chose 415cc - but I'm wondering if I should chose the 385cc to be safe?? (Desired outcome photo below)

Doctor Answers 10

Implants

There is no exact science to what you are saying but many patients ask me this. Every patient is different and if you are on the "Fence" then often patients that go a bit bigger are usually happier if they are in doubt of the original size.


New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast Implant size - pre-op

The answer is not simply yes or no.  The quality and amount of breast skin and strength of the muscle will also influence the final size with sub pectoral implants. Ultimately your surgeon should be very aware of your goals and expectations  and in surgery be ready to alter the final size of the implant as needed.  Sizers are great for this purpose !
Good luck
J Vogel

James Vogel, MD
Baltimore Plastic Surgeon
4.4 out of 5 stars 26 reviews

Behind the Muscle

Hello there Breast implants exert some pressure on the breast . Over time this thins the breast to some extent and some volume loss is seen .Implants behind the muscle are at least partially sheltered from exerting this pressure , so in fact implants behind the muscle are likely to result in a larger size than in front of the muscle .The accurate way to select breast implant size is using the Vectra 3D imaging system and a sizer kit .
CheersTS

Terrence Scamp, MBBS, FRACS
Gold Coast Plastic Surgeon
4.8 out of 5 stars 6 reviews

Choosing a size

Generally speaking, it is better to overestimate than underestimate.  It is far more common for a woman to regret not having gone slightly bigger.  In the end, I wouldn't lose too much sleep over it.  The difference of only 40 cc is not substantial.  Think of it this way:
If you are starting out with 300 cc of natural breast, and add 400 cc implant, that is a total of 700 cc.  So, 40 cc, which you are agonizing over, represents only around a 6% difference.  Probably not worth too much worry, and in the end, most likely a safe bet to go larger. 
Best of luck! Dr. Subbio
Board-Certified Plastic Surgeon
Newtown Square/Philadelphia, PA

Christian Subbio, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 52 reviews

Implants sized vs postop

Hello! This is a great question!I typically tell my patients that a sized implant looks larger than once it will be in place because it is sitting out on your skin and will be compressed once inside the chest. There is no exact correlation. I usually allow for about 25cc difference. You will not notice a significant difference between 385 and 415cc. Having said that, think if you would prefer to be on the larger side vs the smaller side and that should help in your decision making process.Good luck!

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.7 out of 5 stars 39 reviews

Sizers look bigger than the real thing

It is true that if you are using a sizer in your bra to determine your ideal implant size, that the actual results will look a bit smaller when the implant is placed under the muscle.  10% is a fair estimate, but this is not a tremendous amount.  For a 500 cc implant, that means it might look 50 cc smaller.  50 cc is roughly the volume of a golf ball.

John Zannis, MD
New Bern Plastic Surgeon
4.5 out of 5 stars 49 reviews

Breast augmentation

Hello and thank you for your question.   The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 79 reviews

Any implant looks a little smaller under the muscle than above the muscle

It is hard to say exactly what percent difference an implant looks above vs below the muscle.  When an implant is under the muscle the muscle pushes on the implant and changes the shape of the implant making it appear a bit smaller than if it was above the muscle.  The amount of difference depends on how big the muscle is, how big the implant is, and multiple other factors.  Speak to your surgeon for specific suggestions on what will happen in your specific case.  Good luck!

Do you really "lose" 10% when placing round silicone implants under the muscle?

Thank you for the question.   In my opinion, it is not possible to accurately determine how many cc's or how much projection a patient would “lose” when undergoing sub muscular breast augmentation surgery. I suggest patients do not make decisions based on statement such as: “you will lose 25 or 50 cc of volume when breast implants are placed under the muscle”. These statements are simply not reliable enough to utilize clinically. 
  Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery (regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions. I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes.

Implants do not lose volume under the muscle.

Thank you for your question!

There is actually no loss in volume of the implant when placed under the muscle, but there is loss in apparent size and projection. If you were to do implant sizing trials with a brassiere of your choice and had a set expectation in mind with regards to its size, then relative to that expectation, it may appear smaller after surgery when it is placed submuscularly. This is because the implant in a bra is only adding to the projection of the bra, not your body. Submuscularly, the implant is covered by the muscle, the breast tissue, and layers of fat and skin. You may see statements saying that you will lose 25-50 ccs of volume when breast implants are placed under the muscle or that the size will look 10-20% smaller relative to the implant sizers you tried on, but these statements are not clinically reliable or accurate. It varies from patient to patient. If you go into surgery thinking that you will get the exact looks you saw during a bra-sizing trial, then you may be disappointed after surgery. In fact, the most common complaint and reason for revision surgery is not going big enough with implants, so if you are uncertain on size, I recommend going with the slightly larger implant.

That being said, it would be best to focus on having full and natural looking breasts rather than trying to fit into a particular bra-cup size.  Show your surgeons photos of desired final breast, and depending on what look you like, rely on your surgeon's experience and expertise to choose the best profile and actual implant volume to achieve as close to your goals as possible.

The implant has to fit YOUR body dimensions. The more you deviate from the proper fit, the more fake your breasts will look.

Surgeons use what is called tissue-based planning. The planning takes into account the effects of implants on tissues over time, risks of excessive stretch, excessive thinning, visible or palpable implant edges, visible traction rippling, ptosis (Sagging), breast tissue wasting, and your general breast characteristics.

To determine the implant size, breast measurements must be made: 1) Base Width of the existing breast tissue, 2) breast skin stretch, and 3) Nipple-to-Inframammary Fold distance. The combination of these measurements will help determine tissue coverage and the required implant volume to optimally fill the breasts.

Make sure to choose a surgeon you can trust. Your surgeon should be someone who does not rush you, and someone who does not agree to everything you say because safety should be the first thing on their mind. Clearly, you wouldn’t know what is best for you, so they should guide to make decisions that will minimize complications and allow you to have beautiful breasts in the long-term.

Verify their skills, education, and certification. Ask about your surgeon’s experience about the procedure you want and ask to review photographic examples of your surgeon’s work. Check to see if the aesthetic ideal is consistent with what you are hoping to achieve. Make sure the before and after images have the same perspective, the same lighting.  Read the surgeon’s reviews for the procedure you want

Please book an in-person consultation with a board-certified surgeon and make sure to fully and comprehensively share your desires, expectations, and concerns.

Hope this helps

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.