Will gel implants placed under the muscle look smaller than they do when the implant is just tried on in a sports bra?

I'm wanting big full breast in the full C to small D range. I'm currently a small A cup and I'm scheduled for 375cc gel implants. Should I go with a bigger size? I'm not scared to end up with breast that are slightly bigger than planned however I would hate to not go big enough.

Doctor Answers 10

Under vs Over the Muscle

Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle. The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.
Over the Muscle (sub-glandular) – Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.


Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

What size implants


This is a common question asked not only in forums, but also in the offices of cosmetic plastic surgeons. It seems to be a source of some angst for most women as they have tremendous concern for what the final outcome might be. I find that several things over the last 25 years have helped patients decide which type, shape, and projection ratios will best suit their needs. I think it's helpful if the patient brings in several photographs of what the goal look of her breasts might be. Also, if she can bring some photographs of what she doesn't want this will eliminate trying to express in words what “natural”, “high cleavage”, “low cleavage”, “fake”, and “stripper” may mean to her. I have likewise found the Vectra 3-D imaging platform to be the single most helpful tool in trying to visualize what the outcome might be with different sizes of implants. The Mentor shell sizing system,in which a shell of implant material is placed over the breast and in a padless bra, can likewise be helpful in that it can, not only show the size in a bra, but can give the patient some idea as to what the weight of the implant might be.Placing a real implant over your breast, will always look larger than when under the muscle. In my opinion, the implants will look best when the base width of the implant is at, or just slightly less, than a natural base width of her breast. Considerations of chest wall abnormalities, location of breast creases, shapes of the breast, amount of overlying breast tissue, stretch ability of the skin and breast over the implant among other things also play a role in trying to best decide which implant will look best. It can also be helpful if the plastic surgeon, during their consultation, can provide some insight into what the likely outcome would be with different sized implants given their experience in breast implant surgery over many years. We ask our patients to bring different types of clothing such as evening gowns and bathing suits as well as a tight shirt to evaluate what the implant might look like under these type of clothing options. It is also possible to make a home made breast size or using grain rice. Approximately 1 ounce of rice equals 30 mL of breast implants volume. The rice can be placed into a pantyhose leg and enough volume left in the pantyhose such that the rice can be flattened out. You can then tie off the pantyhose and cut off the excess. This flattened rice volume pantyhose can be added on top of the breast inside of a padless bra and can give a rough approximation of what the corresponding implant might look like. Besides the size, most plastic surgical consultations for breast augmentation will also deal with the shape of implants, whether round or anatomically shaped. Here I think the Vectra really shines in that you can place two images next to each other, one with the shaped implant and one with a round implant such that the potential breast implant patient can really see what the difference would look like on them. All things considered, this can be a fun process and the vast majority of patients in my practice are quite happy with their end result. Hope your surgery goes well and good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Will gel implants placed under the muscle look smaller than they do when the implant is just tried on in a sports bra?

Thank you for your question and photographs. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. Remember that there will be a very good size implant that will appropriately fit your anatomy, and your surgeon will help you select them.  Placing large implants in an otherwise tight breast pocket will have difficulty in looking natural, and going larger is often not the best decision from a long-term point of view.  Be sure you understand the risks. Best wishes

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 68 reviews

Picking the right size implant...

Factors relating to choosing the right implant size/style fall into two general categories: your goals and your anatomy.  As far as goals are concerned, focus more on the "look" you are trying to achieve.  Equating cc's with cup sizes has been shown to vary widely and be very unreliable.  Instead of having a goal cup size in mind, try to convey to your surgeon the look that you are going for.  In my practice I ask patients to bring in goal photos from the internet, magazines, etc.  I also use specially made bra sizers as well as 3D imaging to help patients more narrowly define what they are looking for.  Usually between those three modalities, we are successful in narrowing the implant size down to a very specific range.  Second, however, is the consideration of your anatomy.  Specific measurements such as breast width, nipple to fold distance, skin laxity, and others are required to determine the implant sizes and styles that fit within the confines of your anatomy.  At the end of the day, you can't put a size 12 foot in a size 6 shoe so to speak. 

Without this information I referenced which would require an examination of your anatomy as well as a discussion of your goals, it is difficult to answer your question faithfully.  I would offer that for an A cup breast, a 375cc implant is a sizeable implant if that is any consolation.

Good luck!

Charles Galanis, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 20 reviews

Implant size

Everyone's body is ideally designed for a certain implant size. You can "push the envelope" and try to over do it, but that can lead to problems. Starting out an A cup and going to 375 is already a big jump. Unless you have a good distance from your nipple to fold, I wouldn't try and go as big as possible.

Adam J. Oppenheimer, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 200 reviews

Best Breast Implants for ME?

Thank you for the question. In my opinion, it is not possible to accurately determine how many CCs  you would “lose” when undergoing sub muscular breast augmentation surgery. I would suggest that you do not make your decisions based on statement such as: “you will lose 50 cc of volume when breast implants are placed under the muscle”. These statements are simply not reliable enough to utilize clinically.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery (regarding breast implant size/profile selection) 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 are looking for. Ask to see lots of examples of his/her work. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.
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 small 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. Again, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.
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 generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Bigger may be better

Thank for your good question.  This is a very very common question/concern.  The most frequent complaint tends to be that women wish they went larger.  There is ususally a "sticker shock" when they first see their new breasts, but then after a few weeks, they get used to them anad wish they had gone bigger.  Having said that, it depends on what look you are going for - a little bigger, but subtle in a bathing suit, or bigger not caring if people know you had an augmentation.  That decsion could be the difference b/w going bigger or being more coservative.

As far as sizers go, and submuscular implants, the sizers tend to appear larger than the end result with the SM implants.  It is very important to keep in mind that although sizers have a definitive and important role in the consultation process, it is only an approximation of size, shape and location of the implant.

As for your choice 375cc and is this "big enough", everyone's chest anatomy is different (not just the breasts!) and a 375cc implant can look very different in different people, regardles sof intial breast size.

Hope this helped!

Duncan B. Hughes, MD
Durham Plastic Surgeon
5.0 out of 5 stars 4 reviews

Breast Augmentation - Don't want to be too small

Thank you for the question. "Tissue based planning" relies on your chest and breast measurements is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. Choosing an implant too wide or too large will lead to problems in the future which will require additional surgery. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

Steven J. Rottman, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 81 reviews

Placement

Thank you for your question. I do believe that when women choose an implant size based on placing implants in a bra that more often than not they feel they are to small or are not as big as they expected. I would discuss this with your PS. Best of luck

Christopher J. Morea, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 191 reviews

Picking an implant size

Thank you for your question.
When you come in for a consultation, your surgeon takes measurements of your chest and is thinking about those numbers as you pick an implant.  You will lose a little bit of the implant once it is under the muscle, but not enough to change it a cup size.  If you are unsure or think you went too small, I would suggest printing picture off the internet of what you are looking for and go back in for re-sizing to be 100% sure you are happy with your size. This is a big decision you want to make sure you are happy with it.

Francis Johns, MD
Greensburg Plastic Surgeon
4.8 out of 5 stars 73 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.