Saline implants under the muscle for a small frame? (Photo)

I would agree that you appearance is consistent with a constricted or tuberous breast appearance. I have treated this with implants and/or with fat transfer.The issues that need to be addressed with this correction depend primarily with your desires but it appears that you have: 1) enlarged nipple areolar complexes that will likely get larger with augmentation as well as 2) tissue deficiency in the lower pole of the breasts. A dual plane dissection with radial relaxing incisions in the parenchyma carried out with a circumareolar mastpexy (donut) will help to address both of the conditions discussed above. Fat transfer can be done selectlively to enlarge the lower half of the breast but will not treat the enlarged areolae. The patient illustrated below had a different version of constricted breast that was treated with fat injection.

Hi FlowerrChildd,Based on your photo, you might want to consider the dual plane, see the article and video referenced below.Here are a few tips for you because this is perhaps
the hardest decision for a patient to make, as well as the surgeon. Also see
the video attached to my answer. Balancing
the implant to your over-all body shape and tissue cover is essential.The
main thing is to have the diameter of the implant fit the diameter of your
breast "foot print". Cup size estimates can
be misleading, but I generally advise patients that they will experience an
increase of approximately one cup size per 200 cc. You can try on implants in
the office by placing them into a special bra.The implant is also flattened
somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 50 cc (1-2 oz.) is added to the final volume to account for
flattening of the implant in the partial sub-muscular pocket. Once you decide
on a size you like, then add on about 25-50 cc, because in real life the
implant will be flattened slightly by your tissues.Multiple measurements need to be taken to fit
an implant to your exact anatomy. Have your surgeon's office show you the
charts of the implant dimensions for the various profiles of silicone and
saline from the manufacturer. Then you and your surgeon can piece
together the puzzle by matching your measurements, with your wishes, versus
your tissue cover and the available implants to arrive at a surgical
plan.Keep in mind larger implants tend
to have more problems over the years.Since silicone implants wrinkle less than saline implants, they might be
your best bet.You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and
see what you think.Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width.
Multiple measurements of your chest wall are taken (seven in total). Implant
size selection has been an issue of much discussion. Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape. A photo album of patient pictures is maintained to assist them.
These photos ultimately help in determining where the implants will be placed,
since they can be shifted inside (to provide more cleavage), to the outside, up
or superiorly, and down or inferiorly during surgery. In determining the final
size selection, I always place the highest priority on the preoperative measurements
and potential tissue cover. Then, the patient’s verbal requests are factored
into the analysis.Our average size over
the last 7,000 implants was 350. 90% of our patients wish they were bigger a year
after BA.I t is like your mind incorporates the "new you" into it's
self-image over a period of time. We use
the quick recovery approach, so click on the web reference link below to have
this explained and you can see the list of Quick (Flash) Recovery Breast
Augmentation articles from peer-reviewed surgery journals.Be sure
to see only a board certified plastic surgeon (by ABPS - The American Board of
Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic
Plastic Surgery) and or a member of ASPS (The American Society of Plastic
Surgeons). Also, ask if the PS has an established, high volume breast
augmentation practice, performing several hundred breast augmentations each
year. Be sure the PS has been in practice for a while, about 20-years might be
a good gauge.Does the PS offer all
three incisions?Discuss the implant
type (gel or saline), shaped "gummy bear" or non-shaped, smooth or
textured, implant pocket (over or under the muscle) and the "quick
recovery approach."Ask to see
their before and after photos if you didn’t see any on their website. If
they are experienced, they should have several 100 breast implant patients for
you to view. I would also recommend that your doctor offer you the chance
to talk to past patients who would be happy to discuss their experience with
you. You need to feel comfortable, so make sure the environment is safe
as in an accredited surgery center. Also, ask a prospective surgeon if he or
she has ever published journal articles in professional peer-reviewed journals,
which they can provide you.All the
best, “Dr. Joe”

Hi and thank you for your question and picture.  You have a tuberous breast deformity of both sides with asymmetry.  What this means is that you are not a straightforward breast augmentation.  You will require additional work to free up and release the inferior aspect of your breast to produce a pleasing result.  This all being said, yes, saline or silicone implants under the muscle should be able to give you a nice result.  Good Luck!

Thank you for your question.  Based on your photos, you have evidence of tuberous breast deformity.  Your breast augmentation procedure will not be standard. It will take you longer than average to see the final results of your procedure. To get a good outcome, you will need submuscular placement of saline or silicone implants with radial release and scoring of the inferior pole breast tissue which tends to be constricted. The skin of the bottom of the breast is also constricted so it will need time to stretch out to assume a rounder shape.  Once the skin has stretched and the implants have settled, you may need a peri-areolar mastopexy with stabilization of the scar with a purse-string suture to prevent scar widening. This may be needed to flatten out the out pouching of the nipple-areolar area.  This can be done at the same time as the augmentation or in a delayed fashion.  There are several other variations to addressing this kind of deformity such as using shaped implants, internal tissue expansion, or external tissue expansion with fat grafting. Consider an in person consultation with a couple of surgeons and review tuberous breast deformity correction photos to make an informed decision. Best wishes.

Saline and silicone gel implants both can have great results. Saline does have more rippling which may show more in a thin person. Going under the muscle will help. The size is the most important factor and that is something to discuss at the time of your consultation. As long as the implant is proportionate to your body, the skin will not be overstretched.

Thank you for the question and picture. Your breasts do demonstrate some of the qualities seen with tuberous (constricted) breasts; there is a wide range when it comes to tuberous/constricted breast presentation.
Generally speaking, some of the characteristics seen with tuberous breasts include a very narrow base, short distance from areola to inframammary fold, tight (constricted) lower pole of the breasts, relatively wide space between the breasts, "puffy” areola and some degree of ptosis (drooping).
Generally, correction of tuberous breast anomalies involves breast augmentation with areola reduction / mastopexy procedure. The distance from the inframammary fold is increased (to create a more rounded out appearance). Proper implant positioning improves the distance (cleavage) between the breasts. The areola reduction helps to treat the pointed and "puffy" appearance of the areola.Patients should be aware that the final result will take months to see and that they will need to be patient and that revisionary surgery is more likely than in patients who do not present with tuberous (constricted) breasts.
In your case, if the appearance/shape/size of the breasts are a concern, you may be an excellent candidate for corrective surgery.
When you are ready, please make sure you consult with well experienced board-certified plastic surgeons who have significant (demonstrable) experience with this type of surgery. Although I have utilized both saline and silicone gel breast implants for patients in your situation, you made the best off with the use of silicone gel breast implants ( given the paucity of soft tissue coverage along the lower breast poles seen with patients with constricted breasts).
I hope this, and the attached link (dedicated to corrective surgery for patients with tuberous/constricted breasts) helps. Best wishes. 

As long as you don't go to big (less than 300 cc implants), saline should be fine. Based only on your picture, 250 may be a good size. However, you seem to have somewhat constricted breasts which may need to be addressed also. See link below for examples. 

From your photo, the concern is less about the implant and more about the procedure. You have a constricted breast that needs particular attention surgically - release of the lower breast and lifting of the nipple.  And, saline is clearly an inferior choice with respect to implants as they are firmer, ripple more and look less natural - especially in thin women. You should see a board certified plastic surgeon in your area to get a formal opinion through an in-person consultation.Best of luck,
Vincent Marin, MDSan Diego Plastic Surgeon

You do indeed have a small frame.  I believe based on the single photo that you also have tubular breast deformity and ptosis.  I would likely use a textured biodimensional implant with silicone gel for you and do a mastopexy to release the tubular breast deformity and give you a better form after surgery.  If you find a plastic surgery practice that has Vectra 3D computer imaging, the  modeling will show you why you want to do the mastopexy.  I believe you'll have an unacceptable result without it.  I would use the Sientra implant for you because of your thinness.  Unless you have an overfilled saline implant you will end up with visible rippling of your upper poles.  An overfilled implant for you will likely be stiffer and more noticeable to both yourself and others including during intimacy.  That is the main reason that I typically use gel implants.  Find a board certified plastic surgeon in your area, and you'll likely get the same answer.

Saline implants are a good option despite your small frame. When younger, the breast tissue is dense and will cover the implant well and you should have a soft and pretty result.