Breast Implants: What should I ask for? Want: silicone implants, high up, round/full on top, close together (photo)

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

• Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster
when compared to subpectoral augmentation.

• Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

• Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

• Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

• Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

• Subpectoral implants have a lower rate of capsular contracture.


• Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

• The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other. As always, your board certified plastic surgeon can help guide you in your decision making process.

Hello and thank you for your question. Honestly, a formal in-person evaluation would be needed to determine the best treatment. There are several reasons for this:
1) Bra sizes vary based on the clothing store (for example, Victoria's Secret tends to upsize everyone by a whole cup size)
2) Most women do not wear the proper exact fitting bra size for their bodies
3) The exact volume (in cc) needed to change cup size is different for different body types (e.g. 32A to 32D requires a different implant size than 38A to 38D)
4) Be careful NOT to fall into the trap most women do- they see a certain implant size (e.g. 285 cc) or perhaps their friend had a certain size, and they want or request this or another size based on that. Everyone's body is different- 285 cc implants on your friend might look VERY different than they would on you. Be very careful not to make this mistake, because the goal is to find the right size and shape for YOU- for your particular body and your breasts.

Because of those multiple factors, and because it is KEY to fully evaluate your breasts in person to make a full set of precise measurements to select the proper implant for you (incorporating factors like amount of breast tissue, implant type, base width, projection, etc), answering your question really would need a formal personalized consultation- to say anything before that would simply be guessing, which would be both unfair and unhelpful to you. Also, just FYI, each surgeon's measurements are slightly different, so numbers, experience, and overall aesthetic from one surgeon aren't necessarily the same as those from another surgeon!

Your breasts are such a KEY area of your body and your femininity- therefore, you should ONLY trust an experienced aesthetic plastic surgeon. As such an expert, I have had extensive training and experience with complex aesthetic surgeries under a multiple world-renowned experts in the field. I’d recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with aesthetic plastic surgery procedures) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Dear Brenda_27,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Bring goal photos to your consultation and try on sizers as a starting point. Opting for photos that mirror your chest size with your goal breast size/shape ensures you and your surgeon are aligned on the expected results.
As a general rule since you want less projection but a full upper pole, and an augmented look rather than a natural "slope" you likely want highly cohesive implants, a subglandular plane and a lower profile implant with your goal base width.
The attached link has a result that sounds like it may be similar to your goal.

Yes you could have Breast implants under the breast, 375-400 it will look really good, in your case I think it will be good high profile

Hi there,
You would need to be seen in person and the thickness of your breast and skin measured to be sure you are a candidate for subglandular/subfascial.
If you do meet criteria then a moderate or moderate plus profile would give you to look you are after most likely. During the consult the md will go over the levels of upper pole fullness you can achieve with the different profiles and the different gummy bear types.
Bring inspiration photos with you so the MD has a better idea of what you are after
All the best

I would recommend seeing a board-certified (American Board of Plastic Surgery) plastic surgeon with extensive aesthetic breast surgery experience. Ideally, this surgeon has also completed a fellowship accredited by the Aesthetic Society. If you want a more augmented look, I recommend a slightly large volume implant with a slightly higher profile using tissue-based measurements to determine the ideal. When patient's request a larger implant to look more augmented, I will frequently recommend Galaflex (internal bra) to provide long-lasting soft tissue support. We have 3D preoperative imaging capabilities to show you different sizes and how those would look.

You have many very specific goals. There are limits to what changes can be achieved by simply placing implants. Your underlying anatomy will play a large part in the final outcome. Seek a consultation with a board-certified plastic surgeon who can give you realistic answers to your questions, after he or she has had a change to examine you.

To get the result needed, I'd be recommending high profile implants and would recommend getting them done under the muscle. If we do it above the muscle, it won't really give the wanted result, on the opposite you will have a ball shape and there would be deformation on the long term if used above the muscle.

Subglandular placement of implants are associated with higher rates of capsular contracture, implant palpability, and rippling, especially where you want it least, in the upper and central chest. Subpectoral placement is misconstrued for being soft appearing, and there are millions of examples showing that is simply not the case. Implants that have the most projection will give you a more augmented appearance. Incision placement is not just an aesthetic choice, it has a direct effect on risk of capsular contracture and other scar related deformities, and inframammary incisions carry the lowest risk, especially when compared to a periareolar ('nipple') incision. Sizing should be performed to determine the volume necessary to achieve proportion by your estimation; it simply takes the guesswork out and lowers the risk of revision surgery. Surgeons like myself are capable of performing any incision or implant placement, but it is our task to inform you of risks of complications and reoperation associated with the various choices.