30, 5’8” and 145 lbs. Am I a good candidate for over-the-muscle silicone implants without a lift? (Photos)

In some photos your nipples appear to be below your breast fold. For this reason a lift is recommended. This would give you more fullness in the upper portion of your breasts. If your nipples are at your breast fold, you may achieve satisfying results without a lift, however the weight of the implants will probably make a lift inevitable in the future. Your surgeon will recommend a range of sizes and a projection that would achieve your desired goals.

Yes, based on the photos provided you look like a good candidate for OTM breast augmentation. When going over the muscle I always suggest subfascial implant placement because it gives a better upper pole and holds up better over time, and I have done this in patients who look like you and gotten a good result without a lift. You have a slight nipple position asymmetry, so this wouldn't be improved without a lift, but potentially just doing a periareolar lift on the right could fix that if it bothers you. Implants won't provide a lift, but they will fill up your laxity and improve the shape. In people with mild sagging, I actually think subfascial is better than dual plane for shape. Moderate vs high won't provide a big difference in shape, it just depends on your measurements and how large you want to be. Hope this helps!

That’s a wonderful and very thoughtful question, and you’re not alone in asking it. Many women who have mild sagging after breastfeeding are hoping for a fuller, perkier look without needing a lift. The good news is that with your description, slim build, still a fair amount of breast tissue, and only slight laxity, you may very well be a candidate for implants alone, if your nipple position is favorable.
A simple guide: if your nipples sit at or just above your breast crease, implants can naturally fill and lift the breast from within. If they sit below the crease, even slightly, a small lift might be needed to center the nipple and create that youthful contour that lasts.
For women like you who want a natural, soft result, I often recommend dual-plane (under-the-muscle) placement. It supports the tissue beautifully, maintains upper-pole fullness, and helps prevent the “Snoopy” look where the breast tissue droops off the implant over time.
In your case, a moderate-plus or high-profile silicone implant in the 350–400cc range can achieve that elegant balance, fuller but still very natural, with gentle roundness and soft movement.
Ultimately, the best approach is always the one tailored to your anatomy and your vision. When done precisely, it’s entirely possible to achieve that lifted, youthful shape you’re dreaming of, often without a formal lift.
Dr. Sibel Atalay, MDBoard-Certified Plastic Surgeon & Destination Doctor

Dear skylar103,

determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

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

Do I need a breast lift? You might not need one. 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. 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. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

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.

With regards to your other questions:

-Implants do not lift; Based on your photos your nipple position is preserved and a lift seems unnecessary.

-Profile choice has no bearing on the need for a lift: For a given base width a higher profile device will deliver higher volume and greater projection. It is will determine volume and shape but have no impact on lift.

Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other. As always, your board certified plastic surgeon can help guide you in your decision making process.

Thank you for your photographs. A breast augmentation will give you a larger version of the breast that you start with. It does not lift the breast or make it look more perky. From your photographs, you have some stretch marks on your breast meaning that your skin does not have as good elasticity as it used to have. A 350 cc to 400 cc implant, will add additional weight to your breast tissue and cause it to stretch and settle more. Choosing a moderate profile versus a high profile implant would not change the need for a lift. You need to have dimensional measurements done of your breasts and a true determination of your nipple position in relation to the fold underneath your breast in order to give you the very best understanding of what would give you your best result. I suggest that you see a board certified plastic surgeon who can provide all of this information to you. Best wishes.

From the submitted photos it appears you can have a nice result with augmentation alone. You do have some asymmetry in nipple position which will still be present after surgery if a lift isn't performed. You can select either above or below the muscle and still have a good result. There are a few benefits of placing the implant under the muscle including camouflage of the implant in the upper outer quadrant, more natural look overall, and lower capsular contracture rate. Visit with a board certified plastic surgeon near you to learn more.