What percentage of volume in silicone implants are "lost" in sub muscular placement?

Question

I'm having a BL/BA on Sept 7th. I'm trying to decide between 330/345 cc and 360/375 cc. I'm currently a 34 C+/D. How much volume of the silicone implants is lost with sub muscular placement? Should I go for the larger cc amount to make up the lost difference? Will having the lift along with the augmentation make a big difference in choosing which size is best for me?

Robert P. Schmid, MD · Answer

Thanks for your question! I agree that while your concern is real, it is a difficult question, and I'm not sure that there's a definitive answer because everyone's tissue & density is so variable. My good friend & prominent plastic surgeon (who is actually also right by you in FW!) once told me to factor around 50-75cc when going from SG to SM, & in my experience of now doing thousands of breast augmentations, & hundreds of SG to SM implant conversions, that anecdotal rule of thumb has served my very well. Best of luck to you!

Tom J. Pousti, MD · Answer

Thank you for the question.  There are many variables involved when it comes to size concerns, especially with breast augmentation/lifting surgery. You are correct in that there will be limits as to how large of a breast implant can be utilized safely during the procedure.  Remember, that during breast lifting surgery, some skin is removed, thereby limiting the "space" available for breast implants.  On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  In my opinion, it is not possible to accurately determine how many ccs (if any) a patient would “lose” when undergoing sub muscular breast augmentation surgery. I suggest patients do not make decisions based on statement such as: “you will lose 25 or 50 cc of volume when breast implants are placed under the muscle”. These statements are simply not reliable enough to utilize clinically. ***Given that your surgery is coming up soon (and your ongoing concerns), I would suggest that you schedule additional time to spend with your plastic surgeon communicating your goals, preferably prior to the date of surgery.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. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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 him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.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. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes.

Vasdev Rai, MD · Answer

Volume of implant is not lost in submuscular location. Muscle effects projection of implant only. Projection loss of breast depends on many variables that vary from patient to patient.  Your best source for guidance about your confusion is your own surgeon. Have another visit with your surgeon and be clear about your understanding of this operation.

What percentage of volume in silicone implants are "lost" in sub muscular placement?

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What percentage of volume in silicone implants are "lost" in sub muscular placement?

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Everything you need to know about Breast Implants

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