520 cc gel implants over the muscle?

Question

I went for a consultation and my surgeon suggested i go above the muscle because of my lack of breast tissue. I am 5 ft 4 220 lbs and have an a cup breast. He said something about my skin being thick, that is why he thinks on top of muscle would be good for me. But with all im reading, almost all procedured are under the muscle so im having some issues with my surgeons recommendation. Ive invested a lot of time into this and just dont want it to look horrible in a year or two from now. Please help!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question!
  
After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.
  
Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.
  
Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
  
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.
  
We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.
  
The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
  
Best of luck!
  
Dr. Schwartz
  
Board Certified Plastic Surgeon 
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Reza Momeni, MD, FACS · Answer

In general, 520cc implant would be considered a very large implant, but it might be appropriate for you.  Cup sizes are not standard across bra makers, and implant sizing is NOT based on height, weight, BMI, or capsize.  This is something you will need to do IN PERSON with an experienced surgeon to determine what works well for you, and to get advice about if what you like is possible and what to expect with regards to results.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Christian Subbio, MD · Answer

If you really don't have a lot of breast tissue to begin with, and are going with a large implant like 520, my vote would be to go under the muscle to minimize the risk of ripples showing through.  Large implants will stretch your skin and without that extra layer of muscle to pad the implant, visibility, palpability, and rippling are more likely.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  I always advise to be at your ideal body weight prior to surgery.  There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Kenneth A. Godwin, DO · Answer

Hello and thank you for your question. Submuscular implants would be the treatment of choice in your situation. You are stating that you have very little breast tissue to start with and a 520cc implant is large. Placing the implants under the muscle will give you more tissue coverage over your implants and the risk of capsular contracture is decreased. Best wishes.

520 cc gel implants over the muscle?

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520 cc gel implants over the muscle?

Answers (9)

Answer: Breast augmentation

Answer: Breast augmentation

Answer: 520 cc implants over the muscle?

Answer: 520 cc implants over the muscle?

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Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.