Do I have enough tissue to achieve natural results from under the muscle implants? (photo)

Hello, thank you for your question. I would say to bring in wish pics. It really depends what your expectations are. Speak to your plastic surgeon about these options.

Dear aguarino,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You have more than enough tissue to have natural results do in the surgery over the muscle, you will have really good results it will depend on your surgeon

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants, and they choose what looks right for them. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

You are a good candidate for under the muscle implants. Usually you need more tissue for in front of the muscle implants. Your breasts appear asymmetrical in volume, shape and position. You may benefit from a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question and photos. An examination in person is required to properly evaluate you and determine your best options, however based on your photos it appears you have enough native breast tissue to nicely allow for placement of your implant above the muscle in a subfascial plane. The hyper round look relates to volume as well as projection. The higher profile implants will have a rounder look.

Please consult with an experienced board certified plastic surgeon whose aesthetics appeal to you based in his or her Before and After gallery. Best of luck to you.

Examination and actually feeling the thickness of the upper pole tissues is best to determine how well above the muscle will work for you. The type of "above the muscle" placement also matters significantly here. Subfascial breast augmentation (a more modern version of "above the muscle") provides better and more natural upper pole aesthetics long-term than subglandular breast augmentation (the older type of "above the muscle")--there was a very well-done study in 2021 demonstrating this.

I believe you are a pretty straight forward candidate and will receive acceptable results either way. However, is there a specific reason you would like to go above the muscle? This can cause long-term complications. Such as, increase the risk of capsular contracture and increase healing delay/risks if you ever need a breast lift. 

Typically you will achieve the most natural result if you go beneath the muscle. This has a few advantages besides a more natural look including the muscle disguising the upper portion of the implant, as well as a lower incidence of capsular contracture. Speak to your surgeon about what is right for you.

With the size range you chose, I would recommend placing the implants behind the muscle or fascia for better coverage. Otherwise, I would suggest going down in size to around 250-275 cc's.