What is the probability of Lateral Displacement if I go under the muscle (510 cc Silicone Moderate) (photo)

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.   Displacement of implants can happen with either position and depends on your tissue and surgical dissection.Hope that this helps! Best wishes for a wonderful result!

Thank you for your inquiry and congrats on your decision to go forward with your surgery.Lateral displacement is very minimal when your surgery is performed by a well experienced surgeon regardless of the placement of the implants.I hope this helps and the best of luck to you.Ali Sajjadian, MD FACS

The risk of lateral displacement of implants is small whether you go above or below the muscle. In general submuscular implants (dual plane) have advantages over time of a more natural slope to the upper portion of the breast, lower risk of capsular contracture, and more complete visualization of the breast on mammagram. In patients with a history of breast cancer or increased risk, oncologists strongly recommend submuscular position for better visualization on mammagram.

Thanks for your inquiry.  Lateral displacement unfortunately can occur above or below the muscles.  The wider the implant, the more dissection is required laterally to fit the implant.  Discuss with your surgeon your selection of profile of the implant as much as the volume in discussing your risks. Good Luck with your surgery.  

Dear pink diva,   Thanks for submitting your picture and your goal picture. From observing your pictures, you appear to be small A cup. To obtain 34 D cup size, you will need implants with volume  of 500cc. After being 28 years in plastic surgery practice and having operated on thousands of breasts augmentation patients, I place all my implants , exclusively,  under the muscles for the following reasons : 1. Better coverage of the implants . 2. Statistically, less capsule contracture than sub glandular placement. 3. Better preservation of nipples sensation  because the nerves to the nipples cross over the muscle.    To prevent lateral displacement of the implants, my patients wear bras during bed time for one month, to allow the capsule (scar) to strengthen and hold the implants in place. I also teach my patients the technique of implants displacement massage, in order to prevent capsule contracture that might displace the implants laterally or in other direction.  In summary, you should get a very nice and natural results, however, not all results are the same, because experience and skills are of paramount importance. So do your due diligence carefully and wisely. Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive. Pay special attention to te cleavage area, the perkiness, the symmetry and the natural look.                      Best of luck,                                   Dr Widder

Thank you for your photographs and questions.  Based on your pictures it appears that you have little tissue in the upper chest region, and placement of implants above the muscle may cause prominence and visible rippling.  The tradeoff is that placement above the muscle will avoid any possible "animation deformity" when your pec muscle fires which may be one of the reasons your surgeon recommended it.  As far as lateral displacement, it can occur with either location of implant placement, but I think placement of the implant underneath the muscle is a better option in your case, in order to provide a natural appearing breast, with improved soft tissue coverage, and a tendency towards lower complications.  Hope this helps

...wait for 3 months from the day of surgery.   Massaging in my opinion is not needed for my patients. I recommend that hold off from any conclusions for at least 90 days. This is because the body must heal and indeed it does take 3 months for the body to lay down collagen and scar and enter the softening stage. This in adults an take 6-8 months. Continue to be active, in fact I tell my patients to get back or begin getting back into normal activity and working out in 48 hours. The sooner they do, the sooner they feel better.

Generally speaking, with careful pocket dissection and appropriate breast implant selection, the probability of lateral breast implant displacement is small. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular).
I think it is in the best interests of most patients (including athletes)  seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.

On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.

I hope this, and the attached link (dedicated to very active athletic patients), helps. Best wishes.

Lateral displacement of implants can happen if they are over or under.  The larger the implants the more risk of issues.  Good luck.

Judging from the size you are hoping to be,sub glandular may not be your best option. You don't seem to have much tissue in the upper part of your breast so a sub-glandular location my result in visible superior pole rippling.Limiting lateral dissection of the pocket may also help. It probably wouldn't hurt to stay in good sports bra support 24/7 for the first 3-4 months after surgery as your capsule gains strength. Hope this helps, good luck!