I do not want a lift - can I go over the muscle with saline or silicone implant?

Question

Saline or silicone for over the muscle implant? I already have some breast tissue but my boobs are saggy and I don’t want a lift just more volume because I have slightly tuberous breast my lower pole needs to be expanded

Leila Kasrai, MD, FRCSC · Answer

It’s difficult to give you an opinion without photos. However, since you’ve stated that your breasts are saggy, then a lift may be recommended. The implants need to be centred behind the nipples, so if your nipples are located lower down on your chest, that’s where the implants will be as well.This could give you a “rocks in socks” result that may be unsatisfactory. During the lift, the constricted tissue can also be released to make your breasts less tuberous in shape.

Gary M. Horndeski, MD · Answer

The disadvantage of placing an implant over the muscle is 1. the skin envelope is the only thing holding the implant up and 2. the major sensory nerves are cut to the nipple-areola complex. This is often done for tubular breasts. A better alternative is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

John Michael Thomassen, MD · Answer

With this condition, depending on the degree, a breast augmentation alone will not address the herniated breast tissue that puffs out the areola. For this reason a periareolar lift is frequently necessary.  You can do prepectoral augmentation but no clear benefit as a partial submuscular position is just a good at expanding the lower pole.

Brian K. Reedy, MD · Answer

Thanks for your question! Unfortunately, without photos, it is difficult to give you an accurate assessment. I would caution you from trying to avoid a lift if that is what you truly need. Please be sure to consult a board-certified plastic surgeon. Good luck!

Warren Schutte, MD · Answer

Thank you for your question. Without photographs it is difficult to state whether you can avoid a lift or not. In my clinic, I do not perform Mastopexy and Augmentation at the same time. I have many clients with some breast ptosis who choose to have implants placed first as volume is their priority and they are trying to avoid a lift. You will not get as high and tight of a look as a lift would give you, but you will get more breast fullness and some element of lift from the added volume.

Gerald Minniti, MD, FACS · Answer

You don't provide photos, but I'll take your word. Please understand that your unreasonable fear of scars (I presume) is forcing you to make choices that will lead to unhappiness and unattractive breasts; either waterfall deformity, if the implant remains in proper position, or rock in sock deformity, if the implant slides into the copious soft tissue envelope.

Mark E. Mason, MD · Answer

You have a common concern about not wanting a lift. Needing a lift depends on how much your breasts are sagging. Implants will definitely help with volume and fullness, but they will not necessarily help with sagging. It would be best to get a consultation with a plastic surgeon who has experience in performing breast surgery for patients with tuberous breasts as well. In regard to your questions about over the muscle---results are typically more natural looking with implants placed under the muscle. However, this is something to be discussed with your surgeon as well.

Reza Alamouti, MD, FRCS · Answer

Dear Hepburnn That’s a great question, the type of the procedure can only be determined after careful examination. If nipples are not low and puffy, the shape of the breast can be improved by internal scoring and implants.Best wishes

Daniel Barrett, MD · Answer

Dear Hepburnn,
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

Nelson Castillo, MD · Answer

Thank you for sharing your question. Unfortunately without an in-person examination or full series of photographs it is difficult to offer definite advice.  Seek out in-person consultations for the best advice.