Do you really "lose" 10% when placing round silicone implants under the muscle? (I.e. Natrelle Inspira) (photos)
Doctor Answers 10
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 !
Behind the Muscle
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Choosing a size
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
Implants sized vs postop
Sizers look bigger than the real thing
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Any implant looks a little smaller under the muscle than above the muscle
Do you really "lose" 10% when placing round silicone implants under the muscle?
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.
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
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.