Over or under muscle? Teardrop or round for lower positioned breasts? I have consulted 3 experienced doctors.

First doctor chose 425cc, round implants (natrelle), over the muscle as apparently I have enough skin to cover the implant. Second doctor recommended 325cc, round, over the muscle.Third doctor recommended 425-475cc (we agreed to 475cc) but teardrop and under muscle. He advised me that as my breasts sit a bit lower on my chest teardrop implants would be better looking and would fill more top part of my chest. am 175cm tall, 59kg, size 8-10 (small/medium).

Doctor Answers 12

Options for Lower Positioned Breasts?

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Photos would helpful to better answer your question. It sounds as if you have some degree of sagging or ptosis which can be the reason why the surgeons are suggesting an implant on top of the muscle or sub-glandular. While sub-glandular positioning of the implant is considered an acceptable approach, it comes with a number disadvantages. First, a sub-glandular implant will thin your breast tissues, particularly if it is a larger implant. This will put you at risk for a palpable or visible implant and visible rippling over time. Second, the risk of capsular contracture is higher in the sub glandular position, and this can be a very difficult problem to fix when it occurs. 
If your breasts truly are positioned lower on your chest wall, then a teardrop style implant may be a very good choice for your specific circumstances. Depending on the particular type of implant, there are teardrop shapes which are taller than they are wide. This allows for the implant to be placed slightly lower to fill out the tissues lower on your chest wall, while at the some time the implant extends higher up to give you a more natural appearance with better upper breast fullness. In the hands of a skilled and experienced surgeon these implants provide predictable and reliable results with a natural and pleasing breast shape. Placement in the partial sub-muscular or dual plane position is generally the best option.  

Multiple breast implant options

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 As you have probably gathered my new every plastic surgeon has his or her way of dealing with breast augmentation. The more surgeons you will see the more opinions you will get. This can be very confusing and frustrating  I have 30 years of experience with breast augmentation and have been very satisfied with my approach. I use smooth round implants under the muscle and  have a reoperation rate of about 1% for contracture.  In your particular case I would recommend the same. However I would also use Sizer's during the procedure. A sizer is an empty balloon that is placed into the pocket  . It is then filled to the desired size You are then sat up on the operating table to see what the breast looks like. The sizer can be adjusted  to different sizes    This process gives you the optimum customized implant size for your individual body frame 

Andrew Kaczynski, MD (retired)
Sacramento Plastic Surgeon

Implant Types

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Hello,Either round or shaped devices work very well in everybody, and there aren't certain individuals that would be 'better off' with one or the other. Most American surgeons have little to no experience with shaped devices, and have no desire to learn, so they condemn them as inferior to round, which just isn't true. As for placement, most women are better off in the short and long term with subpectorally placed devices. Go visit a few ABPS certified/ASAPS member surgeons that specialize in cosmetic breast surgery.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

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What type and size of implants

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Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a more narrow cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today.Silicone gel breast implants come basically into shapes either round or shaped. They also come with either a textured or smooth surface. In my mind, there are advantages and disadvantages of every scenario and combination of those choices. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. It's then very simple to just look at size and ratio projection to base width and select the perfect implant for that patients shape and desire. Sometimes we would like to use a textured surface implant. Here the advantages are that the textured surface implants tend to migrate less in the pocket, as there is some frictional resistance to motion. Another advantage of textured implants is that the capsular contracture rate, especially when implants put above the muscle, is less than for smooth wall implants. Shaped implants, because we do not want them to turn in the pocket, are always textured. 
Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Multiple opinions

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Thanks for your inquiry, but without a picture and better an exam it is hard to advise.  When I hear that someone has had received multiple different opinions, I suggest you ask the doctors why they think their colleague gave different advice. Clearly the three plans will have a different result.  Good Luck.

Under and round

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Problems with teardrop implant include malposition from textured coat and rotational deformity. Stick with predictable smooth and round under the muscle. Best of luck 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 43 reviews

Implant choices

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Hello, each implant pocket has distinct advantages and disadvantages, but sight unseen it is not possible to comment which option would be suitable for you.  The choice depends on the amount of breast tissue, whether there is any sagging, and other factors.

Confused over Choice of Breast Implant Recommendations

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Breast Augmentation choices can be confusing! The more doctors you see, the more opinions you must sift through. The more  you read on the internet, the more confused things get. There are pros and cons to every method, and every type of implant used. Surgeons all have their own opinions based on their own experience, the type of augmentations they've done, the number they have done, and their comfort in experimenting with different ones. I've been performing breast augmentations for over 30 years and while I've used both shaped and round, over and under the muscle, I find that for women with little tissue to start usually have the best results when using round implants under the muscle. When placed subglandular, rippling and noticeable implants are common and the risk of capsular contracture is greater. While some women prefer shaped implants, and they can achieve nice result, they do carry the risk of rotating into odd positions.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.6 out of 5 stars 73 reviews

So many choices!

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Based on your photo you are a very nice candidate for a variety of implants. I personally prefer to place implants under the muscle to reduce the risk of capsular contracture, and am a big fan of both anatomic implants and smooth round. The choices can be a bit overwhelming and if you can do 3D imaging you may notice some smaller differences to help guide you. I think it is always a good idea to have more than one consultation to see who you really click with and who seems to listen and advise you best.

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 25 reviews

Over or under muscle? Teardrop or round for lower positioned breasts? I have consulted 3 experienced doctors.

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Thank you for your question. Breast augmentation surgery is individualized to each patient. Breast implants are manufactured in a variety of shapes, sizes, and with either smooth or textured surfaces. The method of implant selection and size, along with surgical approach for inserting and positioning breast implants will depend on your preferences and your anatomy and previous surgeries. The shape and size of your breasts prior to surgery will influence both the recommended treatment and the final results. I tell all of my patients “Dimensions and proportions are the determinants of a beautiful breast; not volume.” I recommend that you make an appointment with a board certified plastic surgeon to discuss your breast augmentation options based on breast measurements and tissue dynamics.

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.