Should I get Silicone round implants or textured teardrop shaped implants? Below the muscle or on top of the muscle? (photos)

I am a 30 year old mother of two, which I breastfeed. Before children I was a 34C now I am a 32D. I am looking into a breast augmentation only to fill what I have with as much of a natural appearance as possible. I was originally thinking of 300cc moderate profile textured silicone teardrop implants inserted under the muscle through an incision below the breast. I do not want the curvature most commonly noted on the top of the breast after implants. Any recommendations would be greatly appreciated.

Answers (12)

Choice of implants

surgeons in the United States place implants in the partial sub muscular
space. The upper part of the implant is under the pectoralis major muscle
and the lower part is sub glandular. The advantages are a more natural
shape to the breast, less chance of feeling or seeing rippling, less
chance of capsular contracture and its easier to do a good mammogram. Sub
glandular implants can look very round and may have significant rippling
especially in thinner women. There is also a higher risk of capsular
contracture with sub glandular implants. The disadvantage of sub muscular
implants is that you are a little more sore (which resolves in a day
or two) and you can potentially seeing some breast motion with strong
pectoralis muscle contraction "animation deformity". This is usually
minimal and IMHO is a better trade off than the problems with sub glandular
implants. Total sub muscular refers to also lifting the pectoralis minor
muscle and serratus muscle to achieve total coverage of the implant. It has not
been shown to offer any advantages over partial sub muscular placement but is
more painful and has a higher chance of bleeding. I inject a generous quantity
of long acting local anesthetic into the muscle edges at surgery and most
people have very little pain post op. A biplane procedure involves dissecting
part way above the muscle and they placing the implant in the partial sub
pectoral space. This allows the breast tissue to ride up on the muscle and
can sometimes help avoid having to do a lift. I have not found sub fascial
placement to be of any use. 

current generation of oval silicone implants have a cohesive gel, like bread
dough. It sticks together and will not leak out like the old liquid gel
implants. Highly Cohesive Gel (Gummy Bear) Implants are a type of
silicone implant in which the silicone gel has been made into a solid material
with a consistency much like a gummy bear. The implant has a tear drop shape
and must be held in position by tissue growth into it's textured shell or it
can turn sideways and have an abnormal shape. These implants are much firmer
than  normal silicone gel implants and requires a much larger incision to
be inserted. Drains are required to ensure good tissue in-growth which are
painful and lead to a higher rate of infection and capsular contracture. This
implant is marketed heavily by the implant companies but is unlikely to become
popular for cosmetic augmentation due to its firmness, rippling, necessity for
drains and the large incision necessary for insertion. They are not safer than
the normal gel implants. In fact textured implants are thought to be linked to
a breast cancer called ALCL. You can get a very natural shape and much fewer
complications with the standard oval gel implants.

Under vs Over the muscle

Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle. The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.
Over the Muscle (sub-glandular) – Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.
Larry S. Nichter, MD, MS, FACS
Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
183 reviews

Breast Augmentation/ Breast Implants/ Anatomic Gummy Bear Implants/Silicone Implants/Revision Breast Surgery

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body. Once we determine that we can choose the profile based on what you want or need to achieve.

Implants under the muscle, there is less risk of capsular contracture. Anatomic implants tend to give a more natural shape with more nipple projection.

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

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30 yr old mom wants natural

Your desire for rejuvenation is understandable and so is your request to look natural. What is natural? First, what is not natural? It is as you say the "bulge" of the upper chest which is often approaching the clavicle. 
When you look at results on line, this is commonly seen with large smooth round implants under the muscle.
This is one reason why textured teardrop implants are more natural. They are wider than they are tall and thus put your additional volume where you need it (cleavage) and not where you dont ( upper chest).  Can we please stop thinking of the breast as a beach ball? We must think in 3 dimensions.

The "Like" photo you submitted has a preop breast similar to yours with a straight natural upper chest. The image you do not like is someone not like you with very tight skin. 

The image of you in an orange bikini top shows cleavage with no upper chest bulge. If this is what you desire it can be done with an Allergan 410 implant.

The image of you currently, does not look like someone with a D cup. Something is unusual here.

None the less, if you are currently a D cup it is even more critical to have a higher profile anatomical in order to lift your breast without making it too large. A large smooth round implant under the muscle is the setup for a "snoopy dog" deformity.

Good luck. I hope you make a wise decision.

Should I get Silicone round implants or textured teardrop shaped implants? Below the muscle or on top of the muscle?

Agree with smooth moderate profile + or HP silicone memory gels sub muscle placements via infra incisions

Teardrop Implant Breast Augmentation

For patients desiring the most "natural" augmented appearance, teardrop implants are an excellent alternative to round implants. I use them routinely in patients with little to no breast shape to begin with. Soft tissue thickness, activity level, skin quality, nipple position, chest wall, size, etc. all are considered in the decision making process. It sounds like you've laid a foundation for the entire process of determining what's best for you given your own unique anatomy. That's important as the procedure entails far more than simply inserting an implant device. Your consultation would clarify the details.
Brian M. Derby, MD, FACS
Brian M. Derby, MD, FACS
Sarasota Plastic Surgeon
66 reviews

Breast augmentation

From your photos it appears that you would benefit from a bilateral breast augmentation with  round smooth implants placed over the muscle to achieve your desired goals. Best to seek in person exam by a Board Certified PS

Best Breast Implants for Me?

Thank you for the question.  Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.  If I were seeing you in consultation, I would recommend the use of smooth, round, silicone gel breast implants placed in the sub muscular (dual plane) position.

There are pros and cons to the placement of breast implants in 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.

Generally speaking, 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) that can be seen with breast implants placed in the sub muscular position.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. Therefore, I ask that my patients not base their communication preoperatively OR their satisfaction with the outcome of surgery postoperatively, on achieving a specific cup size. The use of computer imaging may be very helpful during this communication phase.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers, viewing the patient's breasts in the upright and supine position, are very helpful during the breast implant selection process.

I hope this, and the attached link/video (dedicated to breast augmentation surgery concerns), helps. Best wishes.

Which implant is best for me?

Thank you for your question.  This is obviously a crucial part of the decision-making process for you and your surgeon.  There are two primary components required to answer the question.  First, you need to effectively convey your goals.  Providing goal photos and describing the "look" you are trying to achieve goes a long way as do tools such as bra sizers and 3D imaging.  Second, your anatomy needs to be evaluated in terms of assessing skin thickness, laxity, nipple to fold distance, and breast base width among other things.  These obviously require an in-person examination.  In general, in thinner women with small breasts who want a natural look, I think shaped implants provide an excellent option.  On top or below the muscle generally related to how much breast tissue you have and how thick your skin is.  Muscle coverage does provide another layer over the implant to yield a more natural contour.  Furthermore, there may be a slightly decreased risk of capsular contracture in some cases.  Seek out a board-certified surgeon in your area for an evaluation.  Good luck!
Charles Galanis, MD
Beverly Hills Plastic Surgeon

Breast implants

Dear Sackhauser,

Based on your pictures, I would recommend the memory shape (MM) for best and more natural results.  However, an eye to eye exam can help determine the best option for you. Kind Regards, Dr. Gómez. 
Rafael Gomez, MD
Rafael Gomez, MD
Colombia Plastic Surgeon
20 reviews

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.

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