Is It Better for an Implant to Go over or Under in a Tubular Breast?

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.  Above would be the better option, as work on your tissue would be done at the same time.  Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits. Hope that this helps! Best wishes for a wonderful result!

Is It Better for an Implant to Go over or Under in a Tubular Breast? Generally, I prefer to the dual plane approach in which the gland is released above the muscle but the implant is placed below it.
 

Tubular breasts are a difficult problem. You can see by the varied recommendations of some of the finest surgeons below that there is no consensus on how to treat them.
In general , we have several theories about tubular breasts.
1. The lower pole of the breast is tight. We must respect that and not try for too large of an implant. Excessive scoring of the breast can kill the nipple or make it insensate. I have personally seen cases where this happened.
2. I prefer under the muscle augmentations with a conservative size, preferably in the dual plane technique.
3. Every effort should be made to correct the asymmetry as much as possible, usually with silicone implants to avoid the inherent differences between saline and natural breast tissue.
4. Lifts are almost always necessary to achieve relative nipple symmetry and reduce drooping.
5. Patients must be realistic. Their breasts will not be perfect with so many changes being made to the breast at once. Revisional surgeries are common once everything settles down, and an implanted breast ages differently than one with a smaller or no implant, so the breasts will become different over time.
These cases are the graduate course, not Breast Aug 101. You should have the distinct feeling that your prospective surgeon has a concrete plan, has considered all the elements, and is safe.

Hi there-
Because the benefits of placing the implants under your muscle are so compelling, I would recommend this position for you, despite the tubular shape.
Given the tubular shape and your asymmetry, a dual plane technique would be best.

Hello - Yes, tubular breasts can be corrected with implants over the muscle. However, if extensive work will be done around the areola you may want to get the implants under the muscle to prevent any blood flow problems to the nipple-areola area. As far as your risk for breast cancer, check with your family physician about getting tested for the gene. You may want to consider a mammogram before any breast surgery as a baseline to compare with future mammograms. Good luck!