Do I have enough breast tissue for subglandular implants? (Photo)

Thank you for the question. You have good reason to have the implants in the subglandular plane. From the photos you look like you have enough tissue but confirm with your doctor that you have at least 2cm pinch of tissue in the upper part of you breasts during your examination. I would highly recommend getting textured silicone implants as they cause less rippling and less capsular contracture in the subglandular plane. Best of luck,Dr. Khuthaila  

There is a widespread myth for which patients should have a certain minimum amount of breast tissue to be candidates of the above-the muscle placement of implants (my preferred is subfascial). Well, this is false.Most modern trends are the subfascial placement of latest generation implants of anatomical shape, cohesive gel filled and macrotextured; moreover in your case of very small breasts the anatomical shape has a plus of indication, as well as the cohesive silicone gel to avoit the terrible rippling caused by saline implants.

Thanks for your question and photos.  It is difficult to tell from a photo alone, but if you have at least 2cm or so of pinch thickness in the upper pole of your breast you would be a candidate for a subglandular implant placement.  Prior to the moratorium on silicone implants in the early 1990's most implants in the US were placed in the subglandular position, but the ban of widespread silicone gel implants and the forced use of saline implants caused most plastics surgeons in the US to switch to a submuscular position.  Both locations have their advantages and disadvantages.  If you wish to avoid implant distortion due to muscle activation, a subglandular placement is ideal.  You are very thin, so you may require a high profile implant.  I would caution you that a high profile implant in a thin patient placed on top of the muscle will give you a more fake, augmented look.  You will also have a higher rate of capsular contracture which may be reduced by using a textured gel implant.  However, you may notice some "traction rippling" with a textured implant.  Best to be examined in person by a board certified plastic surgeon to discuss further.  Good luck. 

The most common breast implant operation in the world is a sub glandular augmentation. While I perform mostly sub muscular augmentations there are cases such as your request where I am happy to perform sub glandular augmentations. The long term results may not be as good due to the increased rate of capsule formation and the decreased imaging ability for mammograms are well known. As long as you are informed of the risks and benefits of each operation then the choice is yours. Use of specific implants such as a high profile will allow for a 400cc size with out picking an implant that is too wide for your frame. Good Luck!

You appear to have adequate breast tissue to cover silicone implants, but the amount of fat under the skin is also an important factor in whether you can cover an implant above the muscle without rippling or early sag from the weight of the implant on the breast tissue. Since you are thin and have a small frame, I would carefully consider whether to choose an implant that large. You don't say what your size goals are, but with your frame, an implant in the 250-350 range will likely get you a  C or D cup result with fewer risks in the long run. Also, if you are committed to an implant above the muscle, I strongly recommend a textured implant to reduce the risk of capsular contracture and a cohesive gel to reduce the risk of rippling. These are available in both anatomic (tear drop) shape and the more common round shape. Good luck! 

Dear Princess,You appear to have very nice breasts with adequate breast tissue for subglandular placement of the implants.  You will look awesome!  Good luck!

I prefer placing the implants under the  muscle in most cases to provide more soft tissue coverage in the upper pole.

Thank you for the question and pictures. Yes, I think that you do have a significant amount of breast/soft tissue coverage;  the use of sub glandular breast implants is an option.
 Having said that, there are pros and cons to the placement of breast implants and the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.
I think it is in the best interests of most patients 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.  
Best wishes with your decision-making and for an oucome that you will be very pleased with. Make sure that you consider the longer-term outcome ( for example changes in body/breast with time/age) as you make your decisions.

Dear Natalie. Thank you for your question. As noted below there are a number of different approaches to breast augmentation and the pros and cons to each. As indicated, you are athletic and would, therefore, benefit from an implant placed above the muscle. This does have certain disadvantages such as an increased risk of visible and palpable irregularities and also the concerns regarding a higher risk of abnormal scar tissue development or capsular contracture. The bigger concern is raised by the size of the implant that you are selecting as this would definitely stretch your breasts envelope, and like a Chinese finger trap, the more you stretch your skin the thinner it becomes increasing the risk of the concerns that have already been mentioned. An option for you would be to consider the use of fat grafting to supplement the placement of your breast implant. This would allow better coverage and possibly also the use of a smaller implant to achieve your desired result. In any case, it would be beneficial to seek a full consultation with a board certified plastic surgeon. I hope this helps and have a wonderful day. Dr Kayser - Saint Clair Shores

Although I understand your concerns, there are two issues that you need to consider. The first is that giving your size and frame 400 mL implants are probably too large and are at higher risk for complications and distortion of the tissues. The second issue is that you appear to be fairly young and with subglandular implant you will be at higher risk for long term sagging. I think that submuscular implants would still be a better choice using a dual plane approach.