32AA breasts, what are best options for breast augmentation? (Photo)

The most sophisticated approach to
breast augmentation is through the armpit with a surgical camera (transaxillary
endoscopic). Using this modern approach the space can be crafted under direct
vision, with virtually no bleeding and no postoperative bruising. Most
importantly, the shape of the breast is meticulously created. The other, older
methods of insertion are technologically less advanced. Both silicone and
saline implants can be placed through the armpit by a surgeon with skill and
experience using this approach. The incision in the crease is the oldest method
of placing the implants and puts a scar directly on the breast.



A round implant would be a better
choice because they move more like breasts. The anatomic implants have a
textured surface which makes them feel very unnatural. In addition, there is no
benefit to anatomical. There is an X-Ray study that shows the implants from the
side at 6 months. Standing, the round and the antomical implants have the same
profile. When you lie down however, the anatomical implants do not change,
which is unnatural. A round implant will change when you lie down, like a natural
breast would.



HP implants, which are a more modern
shape than moderate profile implants, fit most women better. They have a more
appropriate base diameter and can be made to look very natural or very
augmented, depending on where in the range the implants are filled to achieve a
particular volume. High profile implants are the first choice in my opinion. I
rarely find an indication to use moderate or moderate plus implants. The
subtlety in the final outcome is not achieved by which profile implant is used,
it is determined by the skill in the creation of the pocket, the choice of
volume, and where in the range the implant is filled.



There
are many advantages to sub muscular dual plane placement and very many
disadvantages to sub glandular placement. I would see no indication to do
anything but sub muscular dual plane. Subglandular silicone implant
placement is the historical approach to this surgery, and was widely used in
the 1960's. The implant edges are more visible, the risk of rippling is
higher, the implant is in contact with the non-sterile breast tissue so the
risk of infection and capsular contracture is higher. The interface
between the breast tissue and the muscle is blurred so the implant interferes
with mammography more than sub muscular placement. The blood supply
surrounding the implant is worse so the risk of capsular contracture is higher.
The support for the implant is less so there is more long term shape
abnormalities and sagging. The look of a sub glandular implant is much
less appealing than a sub muscular implant. The placement of sub
glandular implants makes any subsequent revision surgeries more complicated and
less successful. There are no advantages to sub glandular implant
placement.



The choice between saline and silicone
is one that requires a complex discussion of all of the advantages and
disadvantages of both implants. The issues to be considered are safety,
density, mobility, rippling, rupture rate, consequences of rupture, detection
of rupture, need for follow-up care, cost of follow-up, appearance, feel,
sensation of heaviness, radio-density, mammograms, and costs, among other
things. There are advantages and disadvantages of both products. The decision
will ultimately be up to you based on what is appropriate for your particular
situation. Beautiful results can be obtained with either implant.



The best way to determine the size that
fits your personal perception of the perfect breast is to try on sizers. This
way you can see how they fit on you, how they add to your current volume, and
whether they fit your frame. Although the surgeon can guide you, only you will
be able to tell what is the right size. Try on sizers. Measuring a diameter and
then telling the patient what volume they can have (in high, moderate or
moderate plus implants) in my mind is backwards. The patients should be allowed
to choose the volume. Then the surgeon carefully considers the base diameter,
projection, profile, manufacturer, and fill material that will achieve the
patients goals of size as well as qualitative look (natural, intermediate, or
bold upper pole fullness or projection), all the while taking into consideration
the patient's anatomic features that will affect the outcome. The experience of
the surgeon and the degree to which they explain the options to you is of
utmost importance. The subtlety in the final outcome is not achieved by which
profile implant is used, it is determined by the skill in the creation of the
pocket, the choice of implant. Don't let the doctor tell you what would look
good on you. They cannot tell what you perceive to be the best size. There is
no maximum. That is up to you.

Best to get Vectra 3 dimensional imaging, try on different size implants at a plastic surgeons office and get the recommendation of a board certified plastic surgeon in person. Consider pre and postoperative photos that a surgeon can show you.. It looks like you can easily be a B or C cup with good size implants.  

Thank you for your question and for providing the photos.  There are a variety of different implant options available currently, and the proper choice needs to be individualized to meet each woman's unique needs.  These include both saline and two types of silicone implants.  Each has advantages and disadvantages, and these can be discussed during your consultation.  Thin women with minimal breast tissue often do best with silicone implants.  These can be the form stable, anatomic implants or the more traditional silicone gel implants.Given your thin chest and current breast size, it is preferable to place the implants beneath the pectoralis muscle.  This will give more coverage superiorly and medially and minimize rippling and implant show.  While it will be a bit more painful, the discomfort is relatively brief and can be well controlled.  The choice of incision is best discussed with your surgeon, though the beneath the breast (inframammary) choice is most common.I would suggest consulting with an experienced plastic surgeon to discuss your specific needs.  The cost of breast augmentation in my Albany, NY practice ranges from $6000-6800 depending on the type of implants used.  This can also be discussed with your plastic surgeon during your appointment.Best of luck with your breasts.Jeff Rockmore

Even with women with very small breasts can achieve a very natural result with breast implants. Many plastic surgeons will have a gallery of before and after images specifically devoted to women with limited breast tissue and  small implants,  and / or a gallery of athletic patients, many of whom have very limited breast tissue.  Here’s one of the most important things to know about breast augmentation – maybe THE most important: based on the breast soft tissue envelope that you are starting with, and by that I mean the breast skin and subcutaneous breast tissue that will cover the implants, there is a limited range of implant shapes, dimensions and volumes that will produce 1. a natural-appearing result, which provides you with 2. A very likelihood of needing a reoperation (or a series of reoperations) for the problems associated with overly large breast implants: visible implant folds and ripples, implant malposition (usually ‘bottoming out’ and/or ‘lateral drift’), lower pole skin stretch deformity, easy implant palpability, stretchmarks and capsular contracture.And yes I do believe overly large implants have a higher rate of capsular contracture, for any one or all of the following reasons: a possible direct mechanical adverse effect on breast soft tissues, the fact that the bigger the implant is (i.e. the lower the ratio of natural breast volume to implant volume) the more obvious a mild or moderate contracture will be, and my suspicion that surgeons who are willing to place unnaturally large breast implants are, as a group, less likely to be compulsive about using the intra-operative measures and techniques that have been shown to lower the incidence of capsular contracture.

I believe that placing the implants beneath the muscle will help prevent noticable unnatural edges. Silicone gel implants are preferable.  Anatomic or shaped implants may have a role in producing a more natural transition from chest wall to breast mound but I have many nice results using smooth round impants .

 Thank you for the question and pictures. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Generally speaking, I think that it is in most patients best interest to have breast implants placed in the sub muscular (dual plane) position. You will find lots of information about the pros/cons associated with different breast implant positioning on this website.
Otherwise, unfortunately, online consultants will not be able to provide you with specific enough advice (regarding specific breast implant size/profile) to be truly helpful. Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery (regarding breast implant type/size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. In bra sizers can be useful communication tools also. I have found that the use of words such as “natural” or "B or C cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during the communication process.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery ( after the use of temporary intraoperative sizers).
I hope this, and the attached link (dedicated to breast augmentation surgery concerns), helps. Best wishes for an outcome that you will be very pleased with.

Greetings. Based on the photos, you would be a good candidate for implants under the muscle. There are different types of implants. You should seek a consultation with a plastic surgeon in your area.  The surgeon can examine you and discuss the options that would be suited for your needs and expectations. Good luck!

Thank you for your question.  The short answer is a lower profile, smooth round implant placed beneath the muscle will likely serve you best. I use sizers in the office to assess what size the patient herself really wants to be.  This is done with clothing on.  Also, you will likely require a slightly larger or even a higher profile implant on your right based upon the photo supplied.Unfortunately internet recommendation by photographic assessment is obviously very limited.  I would recommend seeing an experienced board certified plastic surgeon to review options with you.  Best of luck.

I prefer especially in very thin patients to place them under the muscle to give  more soft tissue coverage.  You would have to be seen in person to determine what would be best for you.

For someone who is a AA, placement of the implants under the muscle is appropriate as you do not have enough soft tissue coverage for a satisfactory result otherwise. It is certainly more painful for the first few days postoperatively to do so but the goal is a longterm, best case scenario outcome.  I would focus more on shape and achieving as much symmetry as possible than on whether you can be a B or C cup; I suspect that smaller would be preferable in your case given the starting point.  The cohesive implants are very good; I personally find the teardrops to be overrated.  Finally, in terms of the axillary approach, I do not think that this produces the appropriate degree of surgical control or superior results.