Would saline or silicone over or under the muscle work best for me? (Photo)

I'm 5'7" 140lbs with a small b cup (34" band) and looking to be a full C to small D cup with larger but naturally looking breasts. Which would you recommend? Do you think I have enough breast tissue for subglandular placement? Would you recommend this placement? Also, would round or teardrop make the most sense? Thanks so much in advance for your help!

Doctor Answers 34

Breast augmentation choices

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Although I have not examined you in person, necessary for truly meaningful recommendations, I would likely recommend implant placement under the muscle for you. The muscle does an excellent job of covering and padding the upper portion of the implant (the part that is visible in a bra or bathing suit), and is helpful even for patients with more breast tissue. The main disadvantage is increased pain early after surgery, and the possibility that the breasts and implants will move back and forth when you lift weights and contract the pectoral muscles (not a big problem for most patients). I place the implants under the muscle in almost all patients, and I'm never sorry I did so. Silicone implants tend to feel and look softer and more natural, although excellent results can be obtained with saline implants too. I generally use smooth round implants, rather than teardrop. A teardrop implant has to be textured, which may cause the implant to remain higher and look less natural. Extremely natural results can usually be obtained with smooth round implants if the volume and dimensions are properly selected, and the implant pocket is properly created and released. A round implant does NOT need to result in a round breast if you're seeking a natural look.

Orange County Plastic Surgeon
4.8 out of 5 stars 42 reviews

Choices for implants and positioning

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In general, decades of experience have shown that breast implants do better under the pectoralis muscle for the upper half of the breast for both short term and long term reasons. There is very little reason to choose to place implants above the pec muscle. 
For nearly all cosmetic purposes including your situation, there is no advantage in the use of teardrop or shaped implants. Round, smooth surface implants that are properly sized and positioned can give a natural result with less risk of the implant becoming malpositioned in the future.
The choice of silicone gel-filled or saline filled implants is more individualized and has little to do with size or shape of result. Ultimately, the only real advantage of silicone gel-filled implants is that they feel more natural when you can feel them. 
For smooth surface, round implants placed behind the pectoralis muscle, the maximum size increase for breasts (proper width, high profile forward volume) is two cup sizes from where you started. 

Scott L. Replogle, MD
Boulder Plastic Surgeon


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Thank you for your question. While subpectoral placement is often preferable to reduce rippling/complications. Higher projection/profile implants can provide more projecting implants when placed under the muscle as well.

For women with a mild degree of breast droopiness (ptosis), above muscle placement can reshape and perk up the breast tissue more effectively. A moderate amount of breast tissue is necessary to help conceal an implant placed in a sub-mammary pocket. Only a very mild amount of breast droopiness can be corrected in this way and the best placement for you will be determined by your Plastic Surgeon's measurements, assessment of your tissues and your expectations/discussion with them.

I recommend that you discuss your goals with your Plastic Surgeon and ask what they recommend for you. My patients find it helpful to try on implant sizers in office and get a feel for the look of them in their clothing.

All the best

Over or under muscle

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You are very thin with no upper pole fullness.  In my practice, we prefer under the muscle for patients like you.  Be sure to discuss with your own surgeon about how this applies to you, and whether they have any special concerns in your case.

Breast implants?

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Thank you for your question and photos. Due to your photos you would be a candidate for silicone implants placed under the muscle. You would have a better result and also natural look. You can use smooth round implants, I suggest seeking a board certified plastic surgeon for an evaluation and you can also try on some size implants to decide on the size as well. Best of luck! 

Ricardo Vega, MD
Mexico Plastic Surgeon
4.5 out of 5 stars 48 reviews

Saline or Silicone, Subglandular or not, tear drop or not

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Would go with Silicone since you are thin and a saline implant will be more palpable. Would go under the muscle for the same reason and because it is the standard of care these days for many reasons. Would avoid teardrop shape as it can rotate and increase risk of asymmetry in the future especially if you active. In order to determine the accurate implant size that you should consider, I would highly recommend a consultation. Your implant size will be determined by:
1)nipple to inframammary crease distance
2)chest diameter
3)looseness of your skin.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 108 reviews

Breast Augmentation - sub muscular silicone

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Thanks for your question,

You are a good candidate for a sub pectoral (dual plane), smooth or textured (cohesive) silicone, round augmentation via an inframammary incision.  The exact size is best determined in a consultation with your surgeon so that the skin laxity may be assessed.  For your wish to be as natural as possible a sub muscular placement will achieve this.  With respect to round vs anatomical (teardrop) implants, in my experience a round implant will give an equally anatomically sound looking breast in the majority of patients, as most women fall into an average with respect to chest height, width and circumference.

All the best.

Chetan Patel, MD
South Africa Plastic Surgeon

Breast Augmentation

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Hello Jenum24-
You are a great candidate for breast augmentation. I much prefer a smooth, round, cohesive gel implant placed placed under the muscle. This singular plane is under the muscle in the upper half of the breast (as the muscle doesn't exist in inferior-lateral aspect) and under breast tissue in the lower half of the breast. Some people refer to this as 'dual plane' but it is really one plane with different coverings because of normal anatomy. 
Most of my patients (but not all) now prefer using a small inframmary incision as it heals very well and has the added benefit of not going through breast tissue and thus bypasses the theoretical increase chance of 1)contamination/infection, 2)changing of a mammogram, 3)effect on breast feeding and 4)possible inferior areolar edge scar contracture. 

Best of luck.

Mark Anton, MD, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 38 reviews

Would saline or silicone over or under the muscle work best for me?

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Hi Jen,

Based on your photos you appear to be a great candidate for Breast Augmentation surgery. Choice of saline vs. silicone breast implants, over or under the muscle, round vs. teardrop, and size is best determined through an in person consultation. Thank you for sharing your questions and photos. Best wishes.

Dr. Gregory Park

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 178 reviews

Would saline or silicone over or under the muscle work best for me?

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Each surgeon will form an opinion based upon personal experience however my recommendation would be strongly toward considering partial subpectoral placement of round smooth silicone gel implants (cohesive) through an areolar ('nipple') incision.  Large saline implants have a significantly greater risk of feeling like a bag of water and showing future ripples or waviness.
Discuss your options with an ABPS Bd Certified plastic surgeon so you're aware of all options and best of luck.  Enjoy your results.  Jon Perlman MD FACS

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 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.