How much do different placements jiggle and how natural do they feel to the touch?

I am assuming that by "placements", you mean under the muscle or over the muscle. Since you mentioned "jiggling", implants placed above the muscle will "jiggle" more. Another important consideration is that if you are starting out with limited breast tissue, implants placed above the muscle may be more easily palpable.

Dear Optimistic294878,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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.

With regards to your specific situation, smaller patients with less tissue available to camouflage the implants do better with submuscular placement. The alternative often leaves the implant exceedingly noticeable and less "natural."

As always, your board certified plastic surgeon (ABPS) can help guide you in your decision making process.

As you do not have much breast tissue, it makes sense to place your implant beneath your muscle, Dual Plane 2, to give it the most camouflage possible. Your plastic surgeon will perform dimensional measurements of your breast, which determines the most appropriate implant size for you, ie an implant that fits within the normal boundaries of your breast. The next choice would be to choose a level of gel cohesiveness that gives you the soft feeling that you’re looking for. Mentor implants come filled with cohesive I, cohesive II or cohesive III gels. Cohesive one gel is the softest gel and the firmness of the gel increases as the number increases. This would be something you should discuss in detail with your plastic surgeon and have a chance to examine these implants during the time of your consultation. Best wishes.

That’s a really thoughtful question, and it’s wonderful that you’re already thinking about how your results will feel as much as how they’ll look. When planning a breast augmentation, implant placement plays a big role in achieving that soft, natural movement and realistic touch you’re hoping for.
For women with a smaller starting point, like a 32A, placing the implant under the muscle (submuscular) often provides a smoother transition and helps the breast feel more natural once everything settles. This approach can give a softer, more fluid movement as the implants “drop and fluff.”
Of course, every body is different, the best placement always depends on your unique anatomy, lifestyle, and the look you want to achieve. During a personalized consultation, these details are carefully evaluated to design a plan that fits you perfectly. The goal is always to create results that look effortless and feel naturally yours.
Warm regards,Dr. Sibel Atalay, MDBoard-Certified Plastic Surgeon

Choosing the right size and profile breast implants for you. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants, if interested. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Question:
What implant plane should I choose for breast augmentation? I want my results to feel as natural as possible.
Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery – Frisco, TX:
Choosing the right implant plane is one of the most important decisions in breast augmentation — especially when your priority is natural feel and appearance. There are two main options we consider:
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For the most natural results you will want to consider a conservative or moderate sized silicone implant placed beneath the muscle. The muscle provides camouflage for the upper portion of the implant. Placing it beneath the muscle also carries a lower incidence of capsular contracture. Silicone implants feel more like natural breast tissue versus saline implants which feel more like a bag of water. A conservative or moderately sized implant will give you a more natural look versus a large implant. I've included a video I hope you find helpful.