Thoughts on what kind of implants would best suit my body? (Photos)

Question

I’m 5’1, I weigh 108 I would love implants but I’m not sure if UTM or OTM would suit best , or what kind of implants as well

Warren Schutte, MD · Answer

I recommend placing the implants under the muscle for breast augmentation.It is very important that you spend time using "size try-on systems" to see what cc size you desire.

Daniel Barrett, MD · Answer

Dear Loreee27,

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

Robert M. Lowen, MD · Answer

Dear Loree,
  You are not limited in the kind of implant you choose, nor limited in going OTM or UTM.   Sorry, not to simplify things by pointing you in one direction or the other.  You just need to know the pros and  cons of each so you can make the decision that best suits you.
  For example, criteria that are used include your breast and chest width:  yours are not narrow so you can have a full width, implant with moderate projection,  such as an Allergan Soft Touch, SSM moderate profile gel.
   You have moderate lower pole volume ad adequate nipple to fold distance,  so no problems there with respect to size of implant. And you need less volume since you already have a fair amount. 
    You appear to have 2 cm of pinch thickness above the muscle, so  you could go over the muscle without undue visibility, either subglandular or subfascial.  I go under the muscle since it conceals the implant as you get older and tissues thin, in some cases.
    When you get your in-person consultation, any particular concerns can be discussed, and you should do fine, if you stay within the breast footprint dimensions when you choose your size.  Either OTM or  UTM should give you a pleasing result.

Donovan Rosas, MD · Answer

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.

I generally prefer an UTM approach in most cases both for the appearance and longevity of result.

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

Gary M. Horndeski, MD · Answer

Your breasts are asymmetrical in volume, shape and position. One breast is higher than the other. You will need a circumareola approach to correct the areola position. In terms of implants, placing them in front of the muscle has a higher rate of capsular contracture than behind the muscle. I recommend small silicone gel implants placed retro-pectoral.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Under the muscle for the most natural look. Choosing the right size and profile breast implants for you. 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. 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

Gerald Minniti, MD, FACS · Answer

The last 5 years has seen a lot of published data showing improved outcomes with regard to lowering the risk of both capsular contracture and implant malposition with implants placed in a subfascial position. Further, Motiva implants have even lower risk for contracture as well. Placing implants above the muscle allows the muscle to retain its normal position and function, and prevents implant movement or deformity when the muscle contracts. The only limiting factor is tissue thickness. A skin pinch in the upper pole of your breasts should be at least 3/4 or an inch, or 2 cm for subfascial placement (OTM).

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  You are a perfect candidate for breast augmentation.  I would recommend silicone implants under the muscle.  I have been in practice for over 30 years, and revisionary breast surgery is a large portion of my practice.  Over time, the vast majority of implants placed on top of the muscle will slide down the chest wall and oftentimes have significant wrinkling.  You should be able to have an excellent result.  Best wishes to you.

Mehmet Ozdemir, MD · Answer

Given your petite frame and lean build at 5'1" and 108 pounds, you have very little natural subcutaneous fat and breast tissue to "mask" an implant, which makes the choice of placement crucial for a natural look. If you were to go OTM (Over The Muscle), there is a very high risk that the edges of the implant will be visible, leading to "rippling" or a "stuck-on" appearance because there isn't enough tissue to cover the device. For someone with your anatomy, UTM (Under The Muscle) specifically a dual-plane placement is almost always the gold standard, as it uses your pectoral muscle to provide extra coverage over the top of the implant, creating a much smoother transition and a more teardrop-shaped slope. Regarding the type of implant, I’d suggest looking into highly cohesive "gummy bear" silicone implants; they hold their shape better than saline and are less likely to ripple, which is exactly what you want when you have a thinner tissue envelope.

Waylon Zeng, MD · Answer

Hi there, thank you for sharing your story and your photos! I think you would be a great candidate for a breast augmentation. The implant ultimately comes down to surgeon preference. Given your anatomy, either under or over the muscle would be fine. However, I would only recommend using Motiva implants for over the muscle (subfascial) approach as other implants tend to be more noticeable with rippling and implant show unless you already have a significant amount of breast tissue on top to camouflage the implant. If considering the other implant brands, then under the muscle is a more tried-and-true method. The projection of the implant (high or medium profile) would ultimately depend on what your goals are. If you want to more upper pole fullness, then you may want to consider a higher profile implant. Hope that helps!

Thoughts on what kind of implants would best suit my body? (Photos)

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