I am a 27 year old, mother of two. I'm 5'5 and weigh 112 pounds. My breasts have lost volumesince I had my children and had dropped a little. I am now a small B cup and lack volume. I have had 3 consultations with 3 different surgeon each one telling me different. 1 advised over muscle, one said under and the other consultant said dual-plane. How much breast tissue would you say is necessary for over muscle?how do I know best method for me? Am thinking 280cc as want to suit my small frame.help!
Age 27, Mother, 5'5, 112lbs, Breasts Have Lost Volume?
Doctor Answers 9
Its shocking to see that some physicians still recommend placing breast implants above the muscle. Placement above the muscle leads to a myriad of problems and should only be performed in a very few, select cases!
Without seeing your photos I would recommend a dual plane technique that places the implants under the muscle and releases the overlying breast tissue allowing it to redrape over the implants and give you a slight "lift". If the position of your areolas is still not ideal, a small areolar repositioning may be helpful. 280 cc implants are a great choice given your dimensions just make sure they're silicone gel!!!
You present a tough scenario with no pictures for us to judge. Since there are no photos I have never seen your body type I can only speak general. Your situation is common. There are still lots of surgeons that feel above the muscle is a good operation. I do not. There are some situations where it might be good but I really can not think of many. You would be hard pressed to find many younger Plastic Surgeons that do not go under the muscle. I do use the dual plane technique in many patients which is a mostly under the muscle pocket and partially under the gland at the lower pole of the breast. The fact that a surgeon offered that tells me you are borderline for a breast lift. Dr. John Tebbetts is the one who really described the dual plane technique and I would look it up on line. How big you go is so very personal. This can only be determined between you and the surgeon who operates on you. Best of luck!
If the skin and fat pinch of where the upper edge of the implant would sit is less than 2cm it is likely that you will not have enough tissue there to cover the upper edge of the implant if it is placed on top of the muscle. It is not just the amount of breast tissue present it also also involves how it is distributed under the breast skin envelope. The best method for you will depend on your current condition and the surgeon doing the surgery. The same surgical approaches can have different results in the hands of different surgeons. Being conservative in terms of implant size is important but implant shape in terms of projection and diameter is just as important or more so than implant volume. All of these factors need to be taken into account by your surgeon.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
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What type of breast augmentation is best for me?
In order to lessen the risk for capsular contracture and visible implant rippling almost 100%of my patients have sub pectoral augmentation (under the muscle). I often employ a dual plane approach in patients with a little breast drooping or ptosis. I think that having different recommendations can be confusing, but plastic surgery has a lot of variety and that’s what attracts most surgeons to it originally. I would typically look for a sub muscular augmentation as the gold standard, but besides that I would choose a surgeon who you can relate to and trust. Good luck! Dr. Kerr
Implant pocket location
In most patiens I prefer under the muscle( dual plane) because it offers more soft tissue coverage in the upper pole. But, every patient is different.
Above or below the muscle
Getting differing opinions has to only add to the confusion you feel. To simplify it a bit, I think you got two opinions with three names. Implants placed below the muscle almost always fit the definition of dual plane. This means that the implant is partly under the muscle, partly under the breast. (The lower edge of the pectoral muscle is about even with the nipple, so if the implant were entirely under that muscle it would be way too high.)
Now the decision is down to above or below the muscle. Most surgeons in the US prefer under the muscle.
Advantages of under the muscle include:
- implants more likely to stay soft
- breasts look more natural (at least at rest)
- fewer ripples, harder to feel the implant
- mammography a bit better--less breast is hidden
Advantages of above the muscle
- no animation (movement of implant when chest muscles are flexed)
- less discomfort after surgery (just a couple of days)
For weight lifters, body builders, the disadvantage of animation may trump the advantages of submuscular placement. Otherwise, absent some unusual anatomic situation most surgeons prefer submuscular placement.
As far a sizing, that would be determined at consultation. You might have a chance to try on implants which I find helpful.
Thanks for your question, best wishes.
Post Pregnancy Breast Volume Loss
It certainly is not uncommon to lose breast volume following pregnancies, especially in the upper pole. I would suggest placing your implants under the muscle regardless of how much tissue you have since this will provide a more natural result which it sounds like you wish becaus eof the implant size chosen.
I agree with Dr. Pousti's thorough answer. I generally guide patients in your situation to choose under the muscle (dual plane is a form of under the muscle augmentation). My reasoning is that it reduces the rate of capsular contracture, feels more natural, provides more upper pole fullness (which many women want), and hides rippling. Unless you're a weight-lifter, I rarely recommend a subglandular or over the muscle position to patients.
Another technique you may want to choose/discuss with your surgeon is the subfascial option. In this technique, the implant goes under a thin layer of tissue that lies on top of the muscle. This has been associated with lower rates of capsular contracture than the subglandular augmentation, and thus shares pros and cons of both techniques. It's usually an intra-operative decision to do this, as some people do not have a substantial fascial layer, thus, preventing the use of this technique. If you're having a difficult time deciding, then this option may be the best option.
Asif Pirani, MD, FRCS(C)
Confused about Best Option for Breast Augmentation After Differing Opinions?
Thank you for the question.
It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.
Although I cannot provide you with precise advise without direct examination and a full communication of your goals, some general advice may be helpful to you.
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 (note that 2 of your consultants have recommended this approach). 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 these sub muscular position. Also, the immediate recovery period may be more comfortable after sub glandular breast augmentation as compared to sub muscular breast augmentation surgery.
In regards to selecting the best breast implant type/size/profile to meet your goals, it will be very important to have a full discussion regarding your desired goals with your plastic surgeon. 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 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.
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 hope this helps.