Under or over the muscle with gummy implants (BA)? (Photo)

You are a perfect candidate for sub muscular dual plane implants!!!!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.
However, the shape of your breast would require a surgeon that is specifically
experienced in the treatment of ptosis with implants. This can be best
accomplished with the armpit approach. 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.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.

Your question is a good one and in general I prefer the submuscular pocket-- I think it offers less palpability and a more durable result in most cases.  Keep in mind that implant size is also an important factor is creating a nice, natural result that is in balance with your frame, and this is something that's important to discuss with your surgeon.  Great question and good luck!

There are many pro and cons to going over or under the muscle. The biggest reason to go over the muscle is to avoid distortion (or movement) of the implants when the muscle moves. 3 cm of tissue pinch is what tells us that the implants will have adequate skin and tissue covering the implant so it is not visible. It does not make going under the muscle for augmentation the wrong option. Going under the muscle is usually better for many reasons.  It decreases possible complications of augmentation- capsular contracture and infections. It makes the implants less visible.  Based on your pictures, you should be a good candidate for under the muscle augmentation. Good luck! 

Thank you for your question and photograph.  Broadly speaking, breast implants can be placed above or behind your chest muscle (pectoralis).  There is great variability on the answer to your question on this site, so a thorough discussion with your PS is important in choosing the best implant placement for you.  Typically, with an A cup breast, placement of moderate to large implants above the muscle can be problematic: the implant doesn't have as much soft tissue covering in this position which may make the implant more visible over time.  It also has a higher rate of scarring which may be noticeable (capsular contracture), and it will not look as natural as when placed behind the muscle. For these reasons, an implant behind your muscle is probably best.  

 This is a great question and thank you for your photo. On patients like you, it is very hard to convince me to go over the muscle. The benefits of a sub muscular pocket far outweigh those of going over the muscle. This is even more important in women with a very thin, muscular body habitus such as yourself. Implant  palpability, rippling, and capsule contracture are downsides of going over the muscle.  Implant animation that can occur with a sub muscular pocket can be virtually elliminated with full release of the muscle, called a dual plane procedure. Your choice of silicone implants underneath the muscle is the best option for you in my opinion. 

You certainly have the option of breast implants under the muscle or in the dual plane where the implant is also partially subglandular. These options can provide you with excellent aesthetics (youthful breasts). Good luckDr. Burnett

Thank you for your question and for providing a photo for evaluation as well.  The short answer of above versus below is that above the muscle provides a better look for most, better longevity, less risk for encapsulation and rippling, and best option for mammograms.  Subglandular provides the benefit of limiting a dynamic motion deformity. Submuscular wins for most patients!One question is what exactly do you mean by "gummy bear"?  In general, it is a textured anatomic (tear shaped) implant. These implants tend to be firmer, have more edge palpability, and are subject to problems if they rotate.  I would personally favor a smooth round implant in this situation.  Projection (style) of the implant would be dependent on volume and breast base width.  Why you would need an expert in PTOSIS surgery as suggested by one reviewer baffles me personally.  By the photograph submitted and your concerns, I believe you would be an excellent candidate for a straight forward augmentation.  I would personally recommend a smooth round silicone implant placed beneath the muscle.  I would recommend you get a few consultations from experienced board certified plastic surgeons and consider your options.  Best of luck!

I prefer to place implants under the muscle especially in thin patients to minimize the risk of rippling in the superior pole.  Best of luck.

Thank you for the question and picture. Based on your photograph, 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. For example, I have found that the use of words such as “natural” or "C or D 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.