I Need Advice for Breast Augmentation? (photo)

I have seen ps who is very well respected but i am unsure of the advice given due to what i have read. I am 5ft 5in 110 pounds. I breast fed two children my bust dropped from d/d to c cup i don't think they are saggy i do feel they have lost there volume, size. The upper pole being the biggest concern. My ps said he would advise over muscle anatomical 255cc. I want to look natural but want volume and for the implant not to be visible or rippling. Base width diameter is 14.

Doctor Answers 16

Best Breast Implant Size/ Profile for Me?

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Thank you for the question and picture. Although online consultants will not be able to provide you with specific enough advice, some general thoughts may be helpful to you.
The best online advice I can give to ladies who are considering breast augmentation surgery 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're looking for. Ask to see lots of examples of his/her work.

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 “full 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.

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 hope this (and the attached link) help.

Breast Augmentation Advice

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Thank you for your question.

There really is no good reason to place the implants in a subglandular (over the muscle) position. There are some surgeons who prefer this technique but  there are many good reasons to place the implants in the subpectoral position (under the muscle).  In the subpectoral position, you will lower the risk of capsular contracture, rippling, and significant atrophy (loss of breast tissue thickness).     Rippling, implant visibility, breast tissue thinning, and capsular contracture are very common when implants are placed over the muscle.

I generally would use a round smooth implant through an axillary (arm pit) incision for patients with similar breast size and build like you. This provides excellent results and minimizes the risks mentioned above. I do not see any advantage of a textured anatomic implant in your case and you could definitely have a larger implant than 255 cc and still natural. Good luck.

I Need Advice for Breast Augmentation?

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I would consider a slightly larger implant in fact under muscle Sientra texture round base silicone would look great 

Breast Augmentation Advice

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It is important that you become familiar with all of your surgical options and learn the advantages and disadvantages of each.  Specifically, you need to think about the reasons for placing an implant above or below the muscle, the issues related to round and shaped (anatomical) implants, the implications of your chest measurement with respect to your implant size and the pros and cons of saline and silicone implants.  These topics should be thoroughly reviewed during your consultation and you should get several opinions if you are uncertain.  Also, make sure you are comfortable with your physician and that he/she spends time with you and that you are not rushed or pressured.  Although choosing a board certified plastic surgeon is no guarantee of success, I believe it increases the likelihood of a positive outcome.

Advice for breast augmentation

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As you can see from the responses on this site, there is no consensis as to the 'best' breast augmentation for you. You should know that experience has taught us that a smooth round moderate profile submuscular breast augmentation, moderate volume, 350cc and less, gives wonderful results with the fewest problems. Tried and true, this works very well for most who seek breast implants.

Implant issues

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I usually prefer to place implants under the muscle for better upper pole coverage.  I do not like anatomic or textured because the texture does not allow the implants to "jiggle" or move naturally. They get held up.  Anatomics can turn as well.  Go for a second opinion if you are unsure. Good luck.

Advice for Breast Augmentation?

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I concur that your breasts do not sag, and abreast lift does not need consideration. The chosen implant size will probably give you a bit more than a cup size of increase, though there are no uniform definitions of cup size. 

Most surgeons in this country prefer placing the implants under the pectoral muscle. The advantages include:

  • Less chance of capsular contracture
  • Less chance of palpable (and visible) rippling.
  • Less chance of visibility of the upper edge of the implant
  • Better visibility for mammography.

The primary disadvantage is that of "animation" or movement of the breast due to compression of the implants when the pectoral muscle is flexed.

Nonetheless, there are exceptions to all generalizations, and the examining surgeon who discusses the pros and cons with you has an edge over all of us who have only seen one photo. If you are in doubt, a second opinion is in order.

Thanks and best wishes. 


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Gummy bear implants for over the muscle augmentation and less rippling

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I agree that over the muscle placement has some advantages as long as the surgeon puts them in the subfascial plane and not the subglandular plane.  If you want upper pole fullness, then round implants would achieve that better than the anatomics.  The main benefit of over the muscle placement is relates to women who like to do chest workouts (including yoga, Pilates, etc).  If you go under the muscle and work out your pectoral muscles, your breasts will move and look like 2 puppies fighting under your shirt.  Over time, the pectoral muscles will cause the implants to drift apart and downward.  The "gummy bear" silicone implants would be the best for you.  Not only are they cohesive gel, but they are "thicker" than standard implants and have a more form-stable filler that keeps it's shape better with less tendency to ripple.    My website has more info on breast implants if you are interested.  If I can help you in any other way, please contact me.  I hope it goes well.

I Need Advice for Breast Augmentation? (photo)

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Plastic surgery is an interesting specialty as there are often many ways to approach a problem.

This can be confusing to the patient who receives a different opinion from each of the five surgeons they consult.

In your case, however, I would absolutely recommend you have your implants placed under the muscle.

You will receive a more natural look, it will be easier to undergo mammograms in the future and you will have a lower risk of capsular contracture.

I suggest you seek out another experienced aesthetic breast surgeon.

Good luck!

Breast Augmentation Advice

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There is no good reason to place the implants in a subglandular (over the muscle) position, and there are many compelling reasons to place the implants in the subpectoral position.  In the subpectoral position, you will enjoy the benefit of decreasing your risk of capsular contracture, rippling, glandular ptosis (hanging of the breast tissue), and significant atrophy (loss of breast tissue thickness).  Additionally, it is the preferred position for mammograms. The potential issues of 'window shading' or dynamic deformities associated with subpectoral placement are virtually non-existent when appropriately sized implants are chosen.  On the other hand, rippling, implant visibility, breast tissue thinning, and capsular contracture are very common when implants are placed over the muscle.

As far as shaped versus anatomic implants are concerned, your photo suggests that a round/smooth implant will give you an excellent and natural augmentation without the need for a shape/textured implant.

Best of luck!

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.