Surgeon suggested 405-440cc silicone over the muscle, is this an appropriate size to fill and lift my breast? (Photos)

Question

34 years old, 5’4” 135lb breastfed kids, 36D prior to pregnancy and still a deflated 36D due to tissue not fitting in a smaller cup. I am seeking an augmentation without lift, as I don’t want scarring. My goal isn’t necessarily to gain size but fill in my breast pocket for volume and a natural result. My surgeon suggested a 405-440cc smooth silicone mod plus x over the muscle. Does this seem like an appropriate size to fill and lift my breast? Or will I wind up with giant/fake look?

George Volpe, MD · Answer

This size increase that is mentioned in the question for sure will help fill in the skin and give superior fullness to the breasts. However, the prospect of patient posing the question states that increasing volume is not the objective. A 440 mL implant is a medium to large implant that most certainly would increase the size of one's look. It is difficult without a physical examination to determine the laxity of the skin. It is possible a smaller implant could achieve the same results at a smaller volume. There are a number of good implant sizes and profiles by all three of the big implant manufacturers of silicone gel implants that can be considered. It would also be wise to discuss with your surgeon the rationale for over the muscle implants. The majority consensus is that submuscular implants have advantages that outweigh the disadvantages. But there is a significant minority of plastic surgeons who believe in over the muscle implants. Do remember, especially if stretchmarks are present, that it is felt by many that over the muscle implants will descend more quickly than submuscular.

Ted Eisenberg, DO, FACOS, FAACS · Answer

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, if interested, 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

Gary M. Horndeski, MD · Answer

Implants do not lift breasts, just add volume. At size 36 D, each 200 cc of implant corresponds to 1 cup size change. 405-440 cc implants would take you up to a DD. Many women do not like lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  It may seem like a good idea to put implants on top of the muscle in order to fill up the skin envelope and avoid the lift.  In reality, this is the worst thing you can do.  Invariably the skin will stretch and you will have much bigger implants and now require a much larger lift.  Imagine this, you are already drooping and now you are putting a larger weight in your breast after you disconnect the breast tissue from the chest wall.  What do you think will happen?  I have seen this situation go wrong so many times that I actually wrote a paper titled "Poor Practice".  On my breast revision gallery,  you can see the heading termed "long-term changes associated with implants and placed on top of the muscle".  The good news is that with an augmentation and a lift, you can have an excellent long-term result.  Best wishes to you.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend continuing to discuss your concerns with your plastic surgeon or seek additional consultations to ensure that the implants you decide upon are the right ones to meet your expectations. Best wishes!

Daniel Barrett, MD · Answer

Dear aericka54,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

I would suggest considering going down to around 350 cc's which will be a better fit as you age and less weight on your neck and shoulders.  D's are fairly heavy for someone your height and weight.

Camille Cash, MD · Answer

It is difficult to provide a recommendation without an examination or photos.  Implants do provide volume, but they really do not lift the breast.  If you want to raise the position of the nipple you will need to consider a lift.  Otherwise you will end up with large droopy breasts.

Surgeon suggested 405-440cc silicone over the muscle, is this an appropriate size to fill and lift my breast? (Photos)

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