I prefer saline implants under the muscle. Here are the reasons.1. Smaller incisions to place.2. Less expensive.3. Ability to add or subtract fluid after surgery without purchasing new implants.4. If you get a leak, you know it quickly and the saline is the same solution we use in your IV.5. The FDA recommends getting an MRI three years after placement and every other year after to check for leaks with silicone implants. This is not a requirement, but a suggestion. Insurance does not cover this so most people do not get the test.6. The replacement of a ruptured saline implant is quick and easy, often performed under a local anesthetic. The silicone gel implants usually require a complete capsulectomy (removal of inflammed scar tissue envelope) and longer more complicated surgery and recovery.7. The difference in feel of implants if placed under the muscle is negligible. 8. There is a more natural appearance under the muscle without the "softball on the chest" look.9. Less chance of rippling of the skin when placed under the muscle.10. Less chance of capsular contracture under the muscle.
Thank you for your question. You seem to be pretty well informed about what options are available to you and I think that you would do very well with breast augmentation. Going above the muscle, however, can lead to a couple of issues related to possible visible and palpable irregularities. Also the potential rate for abnormal scar Tissue development, called capsular contracture, can also occur at a higher rate above the muscle. The good news is that with anatomical textured implants, there has been evidence showing a decrease with this risk when these implants are placed above the muscle. With the new Gummy Bear type implants, this very well may work for you as you seem to have adequate coverage. I may suggest also that using a smaller implant with the addition of fat transfer could be an ideal solution for you. There is simply nothing more natural than fat. It's yours, it's natural and it has the potential to last a lifetime. Placing the implant above the muscle can also negate a wider gap between the breasts and also what is referred to as an animation deformity when the implant placed under the muscle can contract and cause flattening and other irregularities. In any case, I would recommend a consultation with a board certified plastic surgeon who is skilled in all these approaches. I hope this helps and have a wonderful day. Dr. Kayser Detroit
You are probably a 12.5 cm base width but I would measure then pick a textured silicone if you want subglandular implant. I am guessing if you want more natural look then a lower profile 275 to 325 cc will be in the right range. Good Luck!
I feel that a silicone implant in the submuscular position gives the most natural look and feel for breast augmentation.It also gives you the best chance of avoiding capsular contracture long term. Your nipple position will remain the same with just an augmentation. It could be changed, but would require external scars and I would recommend leaving them in their natural non scar position. Good luck.
I think most professionals and women would agree that silicone gel implants impart a more natural feel to the breasts, that is they are less detectable and possible should someone feel one's breasts. I also think the majority of plastic surgeons would recommend placement of implants to the muscle down on other complications including capsular contracture. This also makes it less likely to be able to feel the implants. Good luck on your endeavor
Thank you for your questions and photographs. You appear to be a very good candidate for breast augmentation surgery. Implants on top of the muscle have a higher risk of capsular contracture, rippling, palpability, visibility and future sagging. I strongly advise putting your implants under the muscle. You can certainly get natural feeling implants with silicone. Because you have widely separated nipples, this may be made a little worse with implants and can't be corrected without obvious scars. Be sure to see an experienced, board certified plastic surgeon.