Should I go for subglandular and 295cc rounded if I want to go for a natural look? (Photo)

I am considering breast augmentation andi have seen many doctors which have given me different options and opinions so im very confused now as to what technique, scar area and volume i should go for. Could i please get some help!? thanks

Doctor Answers 14

The right size for you

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link

The natural look

Hi.  You have experienced the saying that "If you ask 5 plastic surgeons what they recommend for treatment, you get 10 options ;)
In general, for younger people in your situation, I recommend that the implants be placed under the muscle to limit long term displacement issues.  I also recommend that the scar be placed in the inframammary fold.  It looks like 295cc would be a reasonable size for you to look fairly "natural" too.
Best of luck!

Jonathan Heistein, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 22 reviews

Breast augmentation technique, size, and placement

I know that varying options and opinions can be confusing. Without examining you in person, taking measurements, and discussing your exact goals, I am afraid I cannot answer the question about size based only on your photo. I will say, however, that I typically prefer the inframammary incision and submuscular placement of silicone implants to give the most natural results while lowering the risk of complications. Going under the muscle helps camouflage the edges of the implant as well as reduces the risk of capsular contracture. It also prevents the implant from being supported only by the skin as it is in subglandular placement. Subglandular placement relies on the skin to hold the implant up and could increase your need for a lift in the future. I think that you will have a great result!  Make sure you choose an experienced, board certified surgeon. Good luck! 

Ashley Gordon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 31 reviews

What size implants

How to Pick the Right Size and Shape of Breast Implants One of the more frequent questions I'm asked as an aesthetic plastic surgeon for patients considering breast implants is "how do I know what size, and shape I need?” The answer to this question has changed dramatically throughout the 25 years that I've been doing breast augmentation. I've also learned that the words that patients used to describe either what they want or don't want can be completely misleading into what I interpret their meaning to be. Therefore, I like to request that our patients considering breast augmentation bring in photos of both what they think they like and what they don't like. There seems to be a multitude of sources on the Internet where these photos can be downloaded. By looking at the patient's desires, I get a better understanding of what they want. We no longer recommend that we place the exact implant on top of the existing breasts and then place a stretchy bra over it to give us any idea what that exact same implant under the muscle would produce in size. That method, in my opinion, will always over represent what the actual result will be. If you are going to use a sizing type method, then Mentor makes a shell sizing system such that, when the shell size corresponding to the implant that it represents is placed over the existing breast and in a bra, it will better represent what that size implant under the breast and muscle will look like. We've also used 3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this method, a three-dimensional photograph of the actual patient is taken and can be seen on a large screen television by both the physician and perspective breast augmentation patient at the same time. We then can place all of the different implants that are available under that image and decide what size, shape, fill ratio, and height to base width relationships will look best for each patient. Silicone gel breast implants come basically into shapes either round or shaped. They also come with either a textured or smooth surface. In my mind, there are advantages and disadvantages of every scenario and combination of those choices. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. It's then very simple to just look at size and ratio projection to base width and select the perfect implant for that patients shape and desire. Sometimes we would like to use a textured surface implant. Here the advantages are that the textured surface implants tend to migrate less in the pocket, as there is some frictional resistance to motion. Another advantage of textured implants is that the capsular contracture rate, especially when implants put above the muscle, is less than for smooth wall implants. Shaped implants, because we do not want them to turn in the pocket, are always textured. My planning method to optimize the best implant for each patient is begun with a measurement of the base width of the breast. We would then like to subtract about a centimeter and a half total off of that number so as to have coverage of breast tissue over the implant. We then will have a range of implants whose base width matches that number. If we go larger than that number, which sometimes patients will want, we as plastic surgeons know that these larger implants can have more problems down the line. For instance, larger implants may migrate below the crease which one has to lower at the time of surgery in order to get the implant in. When these implants migrate below the natural crease, they can create a second crease in what we call a "double bubble". Large implants can also; because of the pressure they put on the overlying breast tissue, thin that tissue out such that there is less overlying breast tissue over the implant as time passes. After we have the base width, our next decision needs to be what is the ratio of the base width to the projection of the implant. Essentially, there are usually four choices ranging from fairly flat which is called low-profile, to progressively more height and less width with the same volume of silicone gel, which is called ultrahigh profile. There are two profiles in between which are the ones more commonly used and these are called moderate profile and moderate profile plus. Common scenarios in which taller implants would be desired may be in patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that were trying to hold up. For patients who want a more natural look, a moderate profile or moderate profile plus shape is more desirable. There are also anatomically shaped implants. Rather than being around these implants can either be taller than they are wide or wider than they are tall. There are good reasons in patients to use either. For instance, in the patient's with very widely spaced breasts and a large breastbone, a shaped implant that's wider than it is tall can help hide that a little bit. Another example of the patient in who a shaped implant would be best, is that patient with laxity after childbirth or weight loss. When the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant that is anatomically shaped such that the nipple when is it at the lower two thirds of the breast mound created by the implant still looks good and natural and may obviate the need for a breast lift. By spending some time, long before the operation takes place, using the Vectra® 3-D imaging method, we can decide what type, shape, and ratio of width to height would best serve the patient's needs. We can then avoid what is sometimes done which is the placement of sizers at the time of surgery. These sizers, in my opinion, have a few negative implications. One is that there is a cost inherent in using them and usually multiple ones are needed to make a decision as to which implant would look best. I also believe that placing sizers in and out of the breast pocket can be traumatic to that pocket and can cause bleeding. For me, the state-of-the-art in today's breast augmentation is to decide long before the operation exactly which implant would look best using computer animation. A new wrinkle into the choice of breast implants is that breast implants now come with silicone gel that is filled to a higher volume in the shell where it is placed. This will allow for a round smooth implant, for instance to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant. Often times patients will present with breasts that are of different sizes. One of the options to correct this is to use breast implants of different sizes in order to best create symmetry. One of the newer methods to help in symmetry creation is to do what we call a hybrid breast augmentation. In the hybrid breast augmentation, the patient who has asymmetry of the breast to begin can have matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. In that way, no matter what the change in weight of the patient is over time, the breast is more likely to have the same or similar size. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins. With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

Pre aug

From your photos i would recommend silicone and you could go either over or under the muscle.also i would have you consider some fat  grafting to the upper part of your breasts and along your sternum to get more cleavage.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 54 reviews

Implant size

It is very difficult to answer your question without seeing you in person, but in general, most breast augmentation surgeons recommend submuscular implants for a natural look.  Size and shape varies from patient to patient depending on their own goals and desires.

Should I go for subglandular and 295cc rounded if I want to go for a natural look?

Thank you for your question and for sharing your photograph.  Congratulations on your decision to pursue a breast augmentation and I can understand how overwhelming the process must be with all the possible decisions you can make.  I tend to recommend that patients seeking a natural look stick to silicone implants, moderate plus profile, and placed beneath their muscle through a breast crease incision.  The size will ultimately depend on your desired goal appearance as well as on some key breast measurement parameters.  Be sure to see a board certified plastic surgeon, they can help you wade through the decisions to give you the best option. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 reviews

There is no single best option

I am sorry that you are confused about your options for breast augmentation. Please understand that there are many way to get good results and the main thing is to find a surgeon that you relate and seen their results.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 110 reviews

Natural Breast Augmentation with Shaped Implants

If a patient of mine emphasizes a desire to avoid the rounded look of a typical breast augmentation, I favor shaped silicone implants (i.e. Allergan style 410 implants, Mentor MemoryShape implants). These can be placed in the subfascial plane or dual-plane in my hands. I find these planes impact the overlying breast tissue effectively to provide the natural look you seek. In terms of selecting an implant size, trying implants on in clinic, use of the Vectra 3D analyzer, and an in person consultation would help to hone in on the implant size that would work best for your breast shape.

Breast Augmentation/ Breast Fat Transfer/ Breast Implants/ Anatomic Gummy Bear Implants/Silicone Implants

I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.