You certainly can achieve an acceptable result when breast implants are placed beneath the breast after a breast lift. However your long-term risk of capsular contraction and the immediate risk of interference with blood supply to the nipple areola is greater with breast implants placed under the gland.
Placing the breast implants beneath your chest muscle provides protection for the blood supply of your nipple areola, reduces your risk of capsular contraction, and can result in better mammogram examinations in the future.
I think the amount of extra tissue requires a mastopexy for optimal results - otherwise you compromise the long term results. I prefer in most cases under the pect with early mobilization and return to activity. You should be able to continue everything you are active in - my most recent patient owns a gym and is super athletic. If you desire a fuller upper breast with an augmented look go with a round - but the shaped gummy bears give so much projection for their cc volume and basically negate issues of rupture that they are my favorite and I feel best choice for the majority of my patients.
To answer your question of over or under... In plastic surgery there is no right or wrong. Rather pros and cons. This goes for breast augmentation as well. In general if you have enough tissue coverage I prefer to go over the muscle in either the sub glandular or sub-fascial level. The fascia is a thin layer above the muscle but it provides additional coverage to the implant making the superior portion look more beautiful. I think above the muscle looks and moves more naturally. Given your story, dimensions and photos I would likely favour an above the muscle breast augmentation for you. Your surgeon will be able to go over the things more carefully that will help you decide.
Dr. Rodger Shortt
Oakville Plastic Surgeon
Thank you for your question about breast augmentation.
There are pros and cons to putting implants over and under the muscle.
Doing a lift with implants has a slightly higher risk of infection - under the muscle gives a little more protection.
And under the muscle makes capsular contracture less likely (it does not completely prevent it.)
It sounds as though you want the implants over the muscle. It makes sense, provided you understand the pros and cons, the implants are not so large that your breast tissues cannot support them, and provided your surgeon agrees given the quality of your skin. Best wishes.
Thanks for submitting your picture. It would have been helpful to have a side view. In any event, from your picture it appears that you have a C cup size with ptosis level 3 ( severe ) and a full lift ( key hole ) will give you the best result. As far as the breasts augmentation, the submuscular placement of the implants has less likelihood of developing capsule contracture in comparison to subglandular ( on top of the muscle ) placement. If you like the results of your chosen surgeon, listen to his recommendation. However, after 27 years in practice and over 2,000 breasts augmentation patients, the best option, in my opinion, is saline implants under the muscle. In regard to 400 cc implants, you did not give us the chest circumference measurement , so it is difficult to be precise. If you are presently 34 C cup, a 400 cc implants will bring you to a 34 full DD . If that what you had in mind it is fine , otherwise it sounds too big. Always, consult with board certified plastic surgeons and check their before and after pictures to make sure that they are numerous, consistent and you like them. Also, check the reviews.
Best of luck,
From your photo, agree that lift will be beneficial. As far as over vs. under, the best way to determine if over is okay is to pinch test the thickness of the upper pole tissues. (Google high five measurement breast augmentation for more details) If the thickness is sufficient, then over the muscle technically is okay. There are long term tradeoffs with respect to mammograms and capsular contracture when going over vs. under. My personal recommendation is under for those reasons unless there is really compelling reason to go over (e.g. competitive body builder). Good luck.
Your breasts are large and I recommend a new
technique called The Ultimate Breast LiftTM.Instead of a lollipop lift, your breast
tissue is reshaped creating upper pole fullness, elevated higher on the chest
wall and more medial to increase your cleavage.Aligning the areola and breast tissue over the bony prominence of the
chest wall maximizes anterior projection without the use of implants.This technique avoids the ugly vertical scars
of the traditional technique, maintains nipple sensation and the ability to
breast feed.There is no capsular
contracture since implants are not required.Remember, the goal is to have beautiful breasts.Beauty is determined by several factors, not
just volume and implants only add volume.More important is position of the breast on the chest wall, symmetry,
upper pole fullness, cleavage, anterior projection, areola size and a tight
Gary Horndeski, M.D.
Over placement has a slightly higher risks of capsule formation. But your surgeon should have discussed this with you...???
You obviously have a lot of drooping breast tissue and it apears that you have enough tickness to the soft tissue of the upper pole of your breast to cover any ripples in the breast implants. From your photo it apears to me that you have quite a long distance from your imframary fold to the new nipple position so I would imagine that you would be best served with a reduction of that distance which will require a anchor mastopexy instead of a lollipop mastopexy. Putting the implant under the breast is always a better way to augment the breast if there is enough soft tissue in the upper pole. The data shows that there is a definite difference in the capsular contraction rate between smooth wall gel implants and textured gel implants in the sub mammary position. Because of that and several other reasons I would recommend Mentor textured (Siltex) implants. They ripple less, less capsular contraction and they don't bottom out or slide out the side of you breasts.