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

400 cc breast implants placed above the muscle in patients who have relatively small breasts like yourself will have a higher risk of seeing rippling, especially in the the upper half of the breasts. You may want to consider having your implants placed under the muscle to reduce the chance of rippling. Thank you for sharing your photos and question. Best wishes.Dr. Gregory Park

You very nice normal breast anatomy and should be able to achieve an excellent result after breast augmentation.Fortunately her nipple areola position is excellent and is well above the inframammary crease.I strongly suggest that your breast implants be placed underneath the chest muscle.  This will provide better coverage of the implant, a much nicer looking breast after 10-15 years and less risk of capsular contracture.Be aware that complications to increase with breast implants larger than 350 cc.  In my opinion placing the implants underneath the chest muscle reduce the risk of potential complications.

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