Breast Augmentation - size recommendations, lift, over or under muscle? (Photos)

Question

I’d like to get a breast Augmentation. So far I’ve gone to 3 different doctors and they all have said 3 different things . So I’m very confused. Only 1 of them told me I need a lift . One doctor said they wouldn’t let go higher than 350cc . Today the doctor said he would go 450 . I have some loose skin at the top . 1 under over the muscle 2 said under? How do you choose what you think is best? I’m 38 years old my weight is 110 . I know the doctor today said my cm is 13 each .

Gulcin Nujen Cardak, MD, FEBOPRAS · Answer

Hi, thanks for your question. In my opinion you don’t need a lifting surgery. You already have a good amount of breast tissue so both places are safe for you but I would go with over muscle placement. This option will give you more natural and more perky appearance. Also will prevent you from getting possible second surgery to correct waterfall deformity which may cause by under muscle placement. If your breast base is 13 cm you can go up to 450 cc with over muscle placement. For under muscle placement I think it would be wiser to choose smaller sizes.

Chet Mays, MD · Answer

Hi, Thank you for your inquiry! We here at Mays Plastic surgery would love to sit down for a consult to discuss your concerns. With breast laxity you have options. A breast lift, and adding volume, whether its fat transfer to your breasts or implants.  Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

Ellen Ozolins, MD · Answer

Thank you for your question. Your nipple position is above the inframammary fold and points forward, so augmentation with implants alone may be sufficient without a lift. Your breast base width and tissue characteristics determine whether 350 cc or 450 cc is appropriate. Both sizes can fit within a 13 cm base, but the larger implant will provide more projection and fullness; however, the final choice depends on the shape you want to achieve. Regarding implant placement, under-the-muscle positioning is often preferred for women with less breast tissue, as it offers better coverage and reduces visible rippling. Since you have enough tissue to cover the implant, over-the-muscle placement may be preferable. Keep in mind that an implant that is too large could stretch the skin and lead to early sagging.

Brian K. Reedy, MD · Answer

Thanks for your question! I think it really depends on your end goal. It would be helpful to see wish pics to see what you're looking to achieve. Ultimately, go with your gut and whose work you appreciate the most. Good luck!

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos, your ptosis is mild. Nipple position is preserved. You would likely benefit from an augmentation without a lift. From an augmentation plan perspective...I typically recommend submuscular placement. With regards to size recommendations, a 450 ml option would be best with a higher profile device. A 350 ml moderate profile device would be a less dramatic more conservative choice.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Luis A. Mejia, MD · Answer

Dear SLANN, thanks for sharing your concerns and pictures, selection on size and profile is a big journey, however after evaluate your case you look like a great candidate for Breast augmentation with silicon gel implants (probably 350cc) and definitely need a lift. Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia.

Shitel Patel, MD · Answer

It’s normal to get differing opinions &mdash; your case falls into a gray area. At 110 lbs with 13 cm breast width and some loose skin, you’re borderline for needing a lift. Implant size (350cc vs. 450cc) depends on skin quality, tissue thickness, and desired look. Under-muscle placement is often best for leaner patients to reduce visible edges. Focus on your goals (natural vs. fuller look), and choose a board-certified surgeon who explains their plan clearly and aligns with your aesthetic vision. Trust and communication are key to getting the right outcome for you.

Gary M. Horndeski, MD · Answer

You have not told us your bra size or cup size. If you are size 32 or 34, each 100 cc of implant corresponds to 1 cup size change. If you are size 36 or 38, each 200 cc of implant corresponds to 1 cup size change. From this, you can determine the volume required to achieve your desired goal. Your breasts are quite low on the chest wall. If you do not undergo a lift then the implants have to be centered underneath the nipple-areola complex, which is below the inferior edge of your pectoralis major muscle. This means the implants will have no support and will only be held by the skin envelope. I strongly suggest you do the lift first and then, if needed, place implants or fat transfers. The breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear SLANN,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

You have enough skin that you can accommodate a relatively large implant, based on your breast base width. But also, you have enough skin that you have some sagging, which might negatively affect your results if only an implant is place without a lift or mastopexy. Photos suggest a lift would be beneficial, at least on one side (you have asymmetric breast volume and sag), but an in person examination would best determine it. The nipple position relative to the the inframammary fold, as determined by the surgeon, will indicate whether a lift would be beneficial.

Breast Augmentation - size recommendations, lift, over or under muscle? (Photos)

Answers (16)

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