Is 400cc smooth silicone implants above the muscle a good idea for my fit body type? (photos)

Thank you for the question. 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.
There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular). I think it is in the best interests of most patients (including athletes) is seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position. I hope this, and the attached link, helps. Best wishes.

I appreciate
your question.

The best way
to determine implant size is based on chest wall measurements that fit your
body. Once we determine that we can choose the profile based on what you
want or need to achieve.

Implants
under the muscle, there is less risk of capsular contracture. Anatomic
implants tend to give a more natural shape with more nipple projection.

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. SchwartzBoard
Certified Plastic Surgeon

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

Dear Ms. Addams22,Thank you for your, photos, story and questions.  Your anatomy, the filler material (saline or silicone gel) and shape of the implant all play a role in the final appearance.Nothing substitutes for a personal evaluation and a face to face discussion of your options. Unfortunately without a examination and measurements I can advise you in general terms, however I hope you will find them helpful.I personally believe that It is important for prospective breast augmentation patients to understand what determines the appropriate implant size, filler material , shape and implant location. The final decision(s) is a personal choice guided by the experience of your Plastic Surgeon.Your SPECFIC breast anatomy will dictate many of your choices. The breast foot print/base width on your chest will influence implant selection. Disregarding these measured dimensions will often lead to a more visable/conspicuous implant appearance.1)sizing:As far as size you know all bras are not equal in "cup size" measurements."Cup size"is a very crude and non standardized measurement and varies by bra manufacturers. Thus actual cup size you eventually are measured at is not as important as your body proportions as it relates to your desired breast size My specific responses are:A)Realizing there are no standard bra (strap/cup) sizes, purchase several bras (full bodied and no padding) of the strap and cup size you think you want to be. B)take a measuring cup (1 oz=30cc) place rice in a nylon. Therefore 10 oz. = 300cc...C) try on various volumes of rice with some form fitting clothes.D)if implant is placed under the pectoralis muscle I usually add 10% volume to what the patient chooses.... To compensate for the muscle pressing down on the muscle and for the naturally settleing of the implant which often makes the breast appear smaller 2-3 months after surgery.2) profile of implant:A) for the same volume the higher the profile the narrower the base width.B)there is very little difference in projection between a moderate to high profile implantthus little affect on how the actual nipple will look.C) the base width of the breast should equal the base width of the implant D)thus I personally chose the profile based on the patients chest measurements, (a high profile on a wide chest may not result in the cleavage desired and conversely a low profile on a narrow chest may result in implant in the outside armarea).E)Cleavage is largely determined by your anatomy. This can be optimized by choosing the best profile implant and postoperative implant displacement excercises towards the midline of your chest.3)Shape of the implant:A) for the vast majority of cosmetic patients I recommend round implantsB) reconstructive patients shaped/form stable implants are often used4)Placement decision of implant placement will be determined based on your anatomy, you current breast tissue, and your long term goals and benefits.The four positions are:A) Subpectoral which is completely under the muscle. B) Supra pectoral which is above the muscle but under the breast.C) Subfascial which is under the fibrous layer that covers the muscle. D) Dual plane which is partially under the muscle and partially under the breast.Placing the implant in the subpectoral or dual plane position I believe in general has significant benefits: A) coverage of implant with muscle resulting in less palpability of implant (except in lower outer quadrant where ther is no muscle coverage)B) less long term internal scar formation (capsular contracture).5)Filler MaterialA) silicone gel feels more like breast tissue, less potential rippling, comes prefilled cannot adjust size intraoperatively and larger incisions to place compared to equal sized (non prefilled) normal saline implants.B) normal saline implants can be adjusted in size intraoperatively, if ruptures normal saline absorbs, potential increase rippling compared to silicone gel, smaller incision to place normal saline implants as compared to prefilled silicone gel implants.I suggest you collect several nude model photos of the goal breast shape you desire and schedule several consultative appointments with Plastic Surgeons who are experienced and is Certified by the American Board of Plastic Surgery and ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600