Going with 450cc silicone, round, smooth, HP, over muscle. Stats now are 5'1", 115lbs, but I have concerns about rippling?

I would suggest a highly cohesive gel implant to decrease your risk of rippling if you are extremely thin and going in front of the muscle. Just because you like to work out doesn't mean that you have to go in front of the muscle. The animation deformity doesn't always happen, and only happens when you are flexing the pectoralis muscle. Placing the implant behind the muscle will certainly decrease the risk of rippling. Good luck!

I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.  

Silicone will give you a fullness at the top (upper pole fullness).

Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.

These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Hello! I do not like over the muscle implants in petite patients. The implant will weigh down your breast and potentially exacerbate sagging and nipple/areolar stretching. I recommend under the muscle even in my patients who are really into physical fitness, some who compete. The implants will be better supported and certainly much less likely to ripple or cause downstream issues with your breasts. It is extremely difficult to fix a stretched out breast if you decide later in life to remove the implants and lift the breasts.

Hello and thank you for your question. There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile 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. 
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for sharing your question and best wishes with your upcoming augmentation.  I would discuss your concerns with your surgeon as there are steps that you can take to minimize the risk of rippling, one of the easiest being to choose an appropriate sized implant that best fits the dimensions of your chest while selecting a more cohesive gel implant that is less likely to have folds or ripples. It will also afford you a less natural look.  Hope this helps.

It is very difficult to determine the best size you will need (recommended based on your photos) or 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 300 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. The same process goes for just filling in the upper part of your breast without becoming much larger. 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 including silicone vs saline implant

Hello, thanks for your question and provided information. I think 450 cc's are large for a patient with your size and height. there are many risks after every procedure, consult with your surgeon regarding your size, which are the pro's and con's after surgery. 

Thank you for your questions and concerns. You definitely have good reason to be concerned about the appearance over time when placing very large implants on top of the pectoralis muscle with your petite body frame. With this approach there is an increased risk of over stretching with late "implant bottoming out", visible implant rippling and capsular contracture which can cause abnormal hardening to the feel of the implants. If the breast implants are placed in the "dual plane" submuscular pocket, the risk of future implant malposition and capsular contracture are greatly reduced. Also the risk of rippling when placing larger sized implants can be  reduced with the use of the current generation more highly cohesive silicone implants such as the Allergan smooth highly cohesive style implants. I suggest you have a discussion with your surgeon in reference  to all these issues. Best of luck!

You can use a silicone implant that has highly cohesive gel.  Some people refer to this type of gel as a "gummy bear" implant.  You can get the nice strong implant look and very low risk of ripples.
The above muscle implant will have a higher risk of encapsulation that you will have to accept.  Hopefully, it will not be a problem for you.
Best Wishes
Dr. Peterson

When you say "above the muscle" I assume you are referring to a subfascial approach which I use for athletic women who do not want to sacrifice strength.  A standard subglandular approach typically requires a textured device to keep the capsular contracture rates down (and they are still higher than submuscular or a subfascial approach by someone experienced with the technique).As for soft tissue concerns, it is smart of you to consider that.  A fake look (implant that is too big) will have negative consequences over time whether it is above or below the muscle.  The decision on what size to choose should be partly based on your breast size (width specifically) and tissue characteristics.  I use a pinch test in the infraclavicular area and if its less than 2cm or so then the implant edge will be visible.  Some surgeons will use supplementary fat grafting as a way to correct this but its a lot of fancy footwork in the name of breast augmentation.  If someone is too skinny, I will go submuscular even if they are athletic.  You will lose around 30% of the pec major function which is not noticeable in most people unless you are a competitive weight lifter.