Are 350cc Implants Too Large For Over The Muscle Placement For Me?

Dear claire-

 

Regarding your details and the implants suggested to you, you may want to consider trying a different profile breast implant.  You noted that you were given a choice of 290 cc low profile implants, but you may need to mid range, moderate, or high profile breast implants to give you the volume and shape that you want.

You stated that you have some loose skin to fill, which also implies that you could probably more easily accomodate a larger implant.

Your breast and rib cage measurements help to confirm you have a smaller frame, but you will want to see a plastic surgeon in person for the final decision regarding breast implant profile and volume size.  Generally, the breast implants are fitted to your breast width, along with other measurements. 

Although you mentioned in your title question about "over the muscle" placement, you never really talked about it in the rest of your question.  If you have little breast tissue, a smaller frame, and you want to go from 32AA to 32 large C, you may be best suited for under the muscle placement of your breast implants.  This is a little more painful, but has a better "feel" with less chance for rippling or wrinkling, compared to above the muscle placement.

 

Best Wishes to You!

Roy

 

 

Choosing the appropriate size for your breast augmentation relies on many factors including your current breast size, the amount of skin you have, your desired cup size, and your breast and body measurements. You should consult with a plastic surgeon performing breast augmentation regularly who will work with you to pick the right size and profile. It shouldn't be just choosing one of two sizes and the right size for you means incorporating both you and your plastic surgeon's recommendations. Sizing bras do help determine an estimate of the size you hope to achieve. In our Jacksonville breast augmentation practice, we utilize silicone gel sizer to help patients feel comfortable with the size they choose. We also help them decisions by informing them that there can be some limitations according to their existing breast measurements as well as that the sizers appear larger in the bra than inside the body. 

Actually, you need to choose your implant size in a more precise manner than just being handed a certain size.

To accomplish this In our practice, we use the appropriate sized bra, and then the patient tries on each size implant, using a gel implant sizer, until she feels she has exactly the right size for her, not too large, not too small.  Too many times have I seen unhappy patients whose implants are not the "right" size, because the doctor made the choice for them.

The usual implant is the moderate profile in my practice. They look feminine and have nice projection and shape.  Low profile implants are so flat and wide for the volume, they don't do the job that women want. They are certainly not perky.  High profile implants are reserved for women who want more volume but whose breasts are not wide enough for moderate profile, or who just like the look of high profile

Putting the implants partially under the muscle is the only way to provide some soft-tissue coverage in the upper breast for a woman who does not have at least 2.5 cm of pinch thickness in the upper breast. If you don't, and it sounds like you don't, then you have increased risk of issues like implant visibility and visible wrinkling to deal with, if not right away, then down the line when the skin stretches, not to mention the increases risk of capsular contracture when above the muscle.

I think 350 cc will be a better choice to reach your desired cup size in comparison to the 290cc.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

It's hard to fully advise you without a photo.  I have performed over 4000 cosmetic breast procedures and I can't think of any good reason to place implants over the muscle in the situation that you describe.  Again, this is just based on your description and I'd be curious to see your photo as there may well be a good reason why your doctor suggests this.
 

It is difficult to determine without photos. Clear communication with your plastic surgeon is important in achieving the desired goals of the patient.  I like to communicate with patients with “goal” pictures.  During surgery, I use temporary sizers to determine the size/profile that will give the patient the look she is looking for. Trying to predict the size of the implant preoperatively is not ideal.  I think it is too much responsibility for the patient to choose the size of the implant.  Ideally, the surgeon would make that determination once he/she is in the operating room with sizers in and examining the patient in the upright and supine position.  There are many variables that come into play when choosing the correct implant size (how much breast tissue the patient currently has, the shape of the chest wall (concave vs. convex), etc..  It is difficult to determine exact cup size pre-operatively and post-opertatively. Every manufacturer produces a variety of bra styles, which may differ in size and shape.

On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a board certified physician is always the best way to get the most accurate information.

Without a posted frontal photo very hard to advise. but my guess is a 350 to 400 cc would give you a full C cup. 

Dear Claire,

There are several aspects to your question that must be considered. You are clearly a small person so you don't want implants that are too big, making you look unnatural and even, potentially, freakish. Most of my patients do not want to be "showy" but they want to see a difference, in and out of clothes.

After 20 years of practice, I know of no way to pre-size patients accurately in advance of surgery. Simply stuffing implants into a bra tells you nothing about what they will do for you in your breasts- the situations are not comparable. Computer programs cannot take into account the many variable found from one patient to the next in terms of skin elasticity, breast tissue quality, and more. I have found that using breast sizers intraoperatively works best. These are reusable, adjustable breast implants that can be inserted into each breast once the preparation of the implant "pockets" is completed. The sizers can be filled to whatever size desired to see how the breasts look and feel with an implant in them. Some judgement is necessary to be able to visualize the results months down the road. This requires that patients communicate their desires clearly to their surgeon and trust that the surgeon will follow this to the best of his or her ability. Surgeons must also clearly explain the limitations of the surgery.

There is no standard for what an A, B, C, or D cup is. Each manufacturer makes bras according to their own standards and these vary greatly. Using cup size alone as a measure of the surgery is a set up for disappointment. A natural, well proportioned appearance with minimal risks of problems should be the ideal. The best size implant will be greatly determined by what each patient brings to the operating table, literally. I have found that when patients choose their own implant size, they are often disappointed, and usually by choosing too small.

The issue of implant style is interesting and I feel that too much is made of it. The majority of implants used in the U.S. now are round, smooth, moderate profile implants because these produce the best results in  most women with the fewest problems. High profile implants are useful in patients with narrow chests who need or desire more projection with smaller volumes. I rarely use any other style of implant. I do not like the textured or anatomically shaped implants (also called "tear drop" shaped). They have too many problems that I do not want to deal with.

I hope you are successful in achieving your goals. Don't be afraid to ask a lot of question, ask your surgeon to explain his or her recommendations, and, if necessary, seek another opinion.

Sincerely,