Very petite frame, 32A desire for very natural B-C cup. Is silicone a better option? (Photo)
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Doctor Answers 9
Silicone breast implants
Thank you for your question. I believe silicone implants placed under the muscle would give you a great projection and overall result. I would recommend you try on different size implants with different size bras with a tight t-shirt to see what size implant you'd be most happy with. As always, please consult with a board certified plastic surgeon. Best wishes!
The right size for you
Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery
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Best breast implants for me; very petite frame...
For most patients with your petite frame and anatomic starting point, I recommend the use of round silicone breast implants placed in the sub muscular (dual plane) position.
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.
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. For example, I have found that the use of know words such as “very natural” or "C 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, the use of computer imaging has been very helpful during the communication process, in our practice.
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, after the use of temporary intraoperative sizers. I hope this (and the attached link, dedicated to breast augmentation surgery for petite patients) helps. Best wishes for an outcome that you will be very pleased with.
Very petite frame, 32A desire for very natural B-C cup. Is silicone a better option?
What type of Implant
Implant types and other options for Natural looking breasts
I can see that you prefer natural looking breasts.
Before we talk about implants, I would like to discuss what constitutes natural looking breasts, and what factors play a role in creating them.
Natural breasts have the following characteristics:
- The areola – dark pigmented region around the nipples – should not be large relative to your nipple
- The nipple should be above the breast fold – inframammary fold
- The 2 nipples should form an equilateral triangle with the notch of your breast bone
- The breasts should not be sagging
- The nipples should sit directly behind the part of the breast that projects the fullest
- The breasts should appear symmetrical
A recent study by Dr. Mallucci and Dr. Branford, titled “Shapes, Proportions, and Variations in breast Aesthetic Ideals,” gives us 4 set of ideals in beautiful and natural-looking breasts. They are as follows:
- An upward pointing nipple (angled at 20 degrees)
- A slope in the upper pole of the breast
- A tight curvature (convexity) in the lower pole of the breast (i.e., below the nipple)
- An upper pole to lower pole ratio of 45:55 (i.e., the percent of fill below the nipple should be 55% compared to 45% above the nipple)
If your breasts meet these ideals and those I mentioned above, they will look natural.
That being said, there are many factors that go into creating natural-looking breasts, and a combination of the right choices contributes to achieving the desired result. I mention some of these factors below.
- The size of the implant – a large
implant that exceeds your breast boundaries, or overly stretches your breasts,
or is too round will make your breasts look unnatural. In fact, with larger
implants there is higher likelihood of bottoming out (i.e., an empty upper
pole, nipple sitting too high on the breast), double bubble deformity, implant
malposition, implant visibility, breast sagging, and breast tissue wasting. So
going big is good, but going beyond limits will get you in big trouble…pun
- A board-certified surgeon will always determine a suitable range for the implant volume after conducting some breast measurements and this is called tissue-based planning. Measurements such as breast base width, the amount of breast skin stretch, nipple to breast fold distance under maximal stretch, skin quality, chest wall asymmetries, among others have to be looked into. The combination of these measurements will help determine tissue coverage and the required implant volume to optimally fill the breasts. For example, if your breast base is very wide, we will require a higher implant volume to avoid the “rock in a sock” appearance. I am assuming your surgeon already took breast measurements and made the suggestion about the implant size based on them. As such, that would be best for you to attain a natural result.
- The profile of the implant – How much the implant protrudes or sticks out in the forward direction influences how much stretch is put on the overlying breast skin, and excessively stretching the skin results in negative consequences. Although the profile has to be tailored to the width of your breasts, a high profile implant normally provides a more augmented look rather than a natural look. As such, going for a more moderate profile or a moderate plus would be better.
- The shape of the implant – majority of surgeons prefer round and smooth implants, but if your breasts do not have a natural shape to begin with as we see in patients who have tuberous breasts, then you may require the use of anatomic implants (tear-drop shaped implants) whose lower half is more loaded in volume than the upper half corresponding with the desired natural look.
- Incision placement – incision location not only determines the degree of trauma to breast’s soft tissues, exposure of the implant to breast’s endogenous bacteria, pocket visibility and control, but also the implant’s position vertically and horizontally relative to the chest wall. For example, compared to the tranaxillary (armpit) or the areola (around the nipple) incision, the inframammary (IMF) incision better allows your surgeon to lower the inframammary fold to increase its distance from the nipple. In many patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola, and in order to prevent the appearance of excessive upper pole fullness. I need you to realize that an overly full upper pole will make it obvious that you got implants to enhance your breasts.
- Pocket – The decision to go behind the
muscle or over the muscle has to do with the amount of soft tissue coverage –
“padding” under the skin. Choosing a pocket that is tight with sufficient soft
tissue coverage not only prevents implant visibility, palpability, and risks of
excessive stretching on the breast, but also excessive implant movement into
the outer or inner sides of the breasts. A hand-in-glove fit for the implant
allows for a natural and long-lasting result. Your surgeon will do a pinch test
in the upper pole of the breast to see how much “padding” you have. If you have
less than 2 cm, then you do not have much padding and it would be best to go under
the muscle. Generally speaking, if your ribs are visible under the muscle, then
you do not have much “padding.” If however, you have more than 2 cm of tissue,
then you have the option to go over the muscle or under the muscle.
- Which pocket do you prefer?
- OVER THE MUSCLE - If you are hoping to fully preserve the
functionality of the pectoralis major muscle due to athletics or body building,
or if you have a shapeless, constricted, tuberous, sagging breasts without
cleavage, then over the muscle may be a better option.
- Over the muscle implant placement causes less trauma to the chest muscles, and the implants will not be subjected to any pressure or injury due to muscle movement.
- The implant can directly apply pressure on breast tissue to shape the breasts.
- However, over the muscle implant placement may have higher risks of breast tissue wasting, interference with mammography, and capsular contracture compared to under the muscle placement.
- OVER THE MUSCLE - If you are hoping to fully preserve the functionality of the pectoralis major muscle due to athletics or body building, or if you have a shapeless, constricted, tuberous, sagging breasts without cleavage, then over the muscle may be a better option.
- UNDER THE MUSCLE - Under the muscle (partially submuscular)
is a preferred option for many surgeons because the muscle helps to maintain a
slope for the upper pole while allowing for a curvature in the lower pole,
while over the muscle will mostly make your breasts appear round and augmented.
- In thin patients, additional coverage by the muscle reduces the risk of implant visibility in the upper and inner sides of the breasts. It also reduces risk of synmastia, and provides less interference with mammography and breast imaging. It also brings lower rates of capsular contracture.
- However, under the muscle implant placement may allow the chest muscles to put pressure on the implant distorting the breast shape and position in the long-term. You may experience more pain following surgery due to the dissection of some muscle attachments and you may lose strength while flexing your chest muscle and is not suitable for athletes and body builders.
- Which pocket do you prefer?
Now I will discuss about saline vs. silicone implants.
1) Saline Implants
- Since they come in a non-inflated form, the implant can be inserted without having a large incision on the skin and this results in minimal scarring adding to a natural look.
- The non-inflated form also allows the implant to be placed through all incisions including the transaxillary incision which is referred to as the “scarless technique” because there is no scar on the aesthetic unit of the breast itself.
- The non-inflated form allows their volume to be adjusted during operation to make aesthetic looking breasts.
- Saline implants have a 1%/year chance of spontaneously deflating (10% chance after 10 years), and although no one can predict when this will happen, it will be obvious as the breast with implant deflation will reduce in size significantly. Even if the implant ruptures, there is no harm. Saline is “Salt water” which is administered into veins when a person is extremely dehydrated, and thus, it is harmless when absorbed by the body
- Saline may not make the breasts feel natural because it is not compressible – there will be a strong resistance when you squeeze your breasts making them feel firm rather than soft and squishy. However, the difference in feel compared to silicone disappears with the amount of breast tissue you have. Special care should be taken on choosing the right size and shape so that they are proportionate with your overall body contour.
- Saline implants have higher chance of rippling (wrinkling) which may be visible if you have less soft-tissue coverage (i.e., soft tissue refers to your skin, fat layer beneath your skin, and the breast tissue). The thinner you are the more you see it. Rippling often develops on the outer perimeter of the augmented breasts: on the side, bottom or in between the breasts. It can be caused by under-filling of the implant. Solutions would be to choose a moderate sized implant, choose behind the muscle implant placement, choose smooth surfaced implant, and gain weight. That being said, visible rippling can occur with saline implants even behind the muscle on the lateral (outer) aspects of the breast near the breast fold when you lift your arms, or lean forward.
- Silicone as a filler will make the implant feel softer resembling the feel of the natural breast tissue due to its gel-like cohesiveness. This characteristic also makes the implants less detectable even by touch or feel.
- Silicone implants are ideal for thin woman with small breasts
- Silicone implants experience minimal rippling which is barely visible and may occur mostly when patients lie down on their breasts
- Silicone’s cohesive gel allows more a greater variety of implants – i.e, shaped implants are only silicone-based and provide a natural look which is helpful in treating certain conditions related to the chest wall or breast development.
- Silicone implants have a 1%/year chance of rupturing similar to saline implants (10% chance after 10 years), however, the rupture is silent which means that the breast size will remain stable. The downside is that you will require an MRI test to diagnose the gel leakage/rupture. Current FDA recommendation is to have an MRI 3 years after implantation, and subsequently every 2 years.
- Silicone implants cannot be safely introduced behind the breast through the transaxillary incision unless they are small or moderately sized (>500 cc).
- Silicone implants appear in a pre-filled form which means implant insertion requires a longer incision on the skin to prevent its damage, and its volume cannot be manipulated.
The New Silicone Implants:
There is often a concern over safety and monitoring of silicone implants, but these implants have a similar complication rate compared to saline implants. Several clinical trials have shown the safety and longevity of silicone implants that allowed them to be approved by the FDA since 2006. Please note that today's 5th generation silicone cohesive gel implants have been proven to be very durable and safe. In fact, they have lower rates of capsular contracture and gel diffusion. These 2 things were the major concern from previous silicone implants. The new silicone implants also have thicker shells, wider variety of surface textures, and implant shapes.
Both saline and silicone implants are very safe and durable, and there is almost no difference in terms of safety. However, if your question considers only the filler of the implant, then saline solution is inherently safer when exposed to the body compared to silicone which can cause an inflammatory response.
NEW IDEAL IMPLANTS
If your major concern is safety, and you also prefer a natural look, then the new IDEAL Implants may the right choice for you. IDEAL implants have been created to provide the natural look and feel but with saline as a filler rather than silicone. The unique structure of the IDEAL Implants allows for a similar look and feel as silicone with the safety of saline. Ask a board-certified plastic surgeon about IDEAL implants.
I hope this information is helpful.
Please consult a board-certified plastic surgeon about your options for breast augmentation.
Natural Breast Augmentation
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.