Are over muscle, silicone, low profile implants that aren't too big best for a very natural look?

Dear naturalook,
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

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

The main reason breast implants are placed below the pectoral muscle is to offer much more protection against scar capsule contracture, which is the tightening of scar tissue around breast implants that hardens and distorts the breast.  This problem is much more likely when implants are placed above the muscle.  Therefore, I usually recommend against placement over the muscle.  However, it is true that implant placement over the muscle will give more of a lift to the slightly saggy breast, which your photos show.  In addition, due to your overall breast and chest size, I think a moderate profile implant might be best.  But most importantly, your choice of implant position may depend on your acceptance of the increased risk of capsule contracture with placement over the muscle.

You have ptotis breasts with a wide base width.  I would recommend a high profile device in a dual plane which is partially under the muscle for a nice result.  A low profile implant would make your breasts look too wide in my opinion. 

Questions regarding which type, style, and shape of implant to use are best answered in consultation with a board-certified plastic surgeon who can examine you in person and review your options with you.  That said, if you do not have a lot of tissue coverage, it is alway nice to recruit extra coverage from the chest muscle by placing the implant under the muscle.  One of the other issues regarding above-the-muscle placement is that it increases the risk of developing a capsular contracture, the thick scar tissue capsule that can form around an implant thus making the breast feel firm or distorting the way it looks.  Statistically, this is a bigger risk when implants are above the muscle than when it is below the muscle.  You can decrease this risk somewhat by using saline implants (lower risk of capsular contracture) but, without the additional muscle coverage, you might feel rippling, which is the big issue with saline implants.  If you are concerned about scarring, you might also consider the TUBA (trans-umbilical breast augmentation) procedure, a technique for inserting saline implants through an incision in the belly button.  Bottom line:  You should schedule a consultation with one or more board-certified plastic surgeons in order to obtain differing perspectives.

Hi.  To appropriately discuss implant size and choice, as well as placement above or below the muscle, you really need an in person evaluation by a plastic surgeon with good experience with breast augmentation.  Opinions and preferences will vary somewhat from one surgeon to another surgeon.  Personally I start with the base width of the patient as the starting point for the footprint of the future implant.  Tissue characteristics, and desired postoperative size, and patient anatomy all factor in to the proper selection of implant volume, profile and submuscular versus subglandular placement.  I go over all of that all in detail with my patients at the time of their consultation.
I would recommend consulting with a board-certified plastic surgeon with good experience in this area.  He or she can thoroughly review the options with you so that you can make a good and well-informed mutual decision.
Good luck and take care,Dr. Howell

Your breasts are low on the chest wall and widely spaced.  You would benefit from a lift more than augmentation.  The 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 and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Based on your photos alone, it would appear that most of the droopiness to your breasts could be achieved with adding enough volume by use of an implant. An alternative would be to combine a smaller volume implant with a mastopexy, or lift. An examination, and knowing what your desired result is ,would be necessary in determining what choice is appropriate for you. I rarely recommend placing implants on top of the muscle, particularly in patients that have limited soft tissue coverage. This interrupts much of the blood supply to the breasts, significantly increasing the risks of complications if the patient requires a lift at a later time. It also results in the implants being more visible/palpable than a partial  submuscular placement. Consult an experienced surgeon to discuss your desired results and what should be done to best achieve them.

Hello and thank you for your question. There are several advantages and disadvantages to over vs under the muscle.  Under the muscle has the advantage of lower capsular contracture rates, less risk of rippling, and better visualization with future mammograms.  Most patients say that under the muscle also has a more natural look and feel.  The size, shape, and profile of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

Good afternoon, Naturalook.  There are definitely a myriad of pros and cons of going over the muscle vs. under the muscle, as well as silicone vs. saline.  An experienced, well-trained plastic surgeon would be in the best position to make recommendations for you, based on an in-person physical exam, history, as well as discussion of your goals.  In reviewing your photos, it appears that your breasts are fairly low and that there is some elongation.  Placing the implants over the muscle in this scenario may give a more "balanced" look, as opposed to under the muscle, and hence a more natural look.  However, if you don't have a lot of breast tissue as you mention, then rippling and a sharp outline of the upper implant may be evident, making the result unnatural.  Additionally, there may be a higher risk of capsular contracture, aggravated by the above-muscle placement.  Further, placement of the implants above the muscle results in less support of the implant with a higher likelihood (and earlier occurrence) of further breast stretch and "sagging."  Another long-term consideration of sub-glandular (above the muscle) placement, is the severance of the deep breast blood supply, potential critical with future surgery -- particularly a breast lift.  In my opinion, the low profile implant may not give you the enhancement that you might desire.  Overall, silicone implants are a little wider and flatter than saline.  The low profile really has a more "disc" shape -- it will fill out the entire breast nicely, but just not add enough Oomph :)  The moderate or moderate plus will give nice fill with a little better projection and contour.  Another aspect of the implants to discuss with your surgeon is the amount of fill within the implant.  This varies by implant manufacturer and implant style.  Implants with less fill will have some caving in the center, like an ashtray.  Additionally, the degree of cohesiveness of the silicone will impact the degree of rippling and firmness of the implant, as well as the degree to which the implant is flattened when placed inside (which affects the degree of projection and upper pole fullness/convexity).Best of luck to you, and I hope you are able to achieve the results you are looking for, should you decide to proceed with a breast augmentation!  Dr. Ghafoori