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

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

unless you are in body building  contests, go under the muscle you will have less capsular contracture and less rippling

You small preop breast size puts you at risk for rippling after augmentation if you choose the subglandublar pocket placement.  I'd suggest a submuscular pocket to get more coverage over the implant.  

Hello. You would benefit from a breast augmentation. You would need to see a BCPS for an examination and breast measurements to determine the best implant size. Goal photos or a simulator photo are also very useful to convey your expectations to your surgeon.Above the muscle has been suggested for patients that work out but this concept is a fallacy. Below the muscle creates better aesthetics. Discuss the possibilities with your BCPS. 

Thank you for the photos and questions. In regards to placing breast implants above the muscle vs. below the muscle vs. dual plane there is good evidence that total or partial muscle coverage (dual plane) of the implant helps to reduce the incidence of capsular contracture (heavy scar tissue around the implant) which can make the implants feel excessively firm. Complete discussion of the pros and cons is beyond the scope of this forum. Ask the surgeon why he/ she recommends above the muscle and feel free to get a second opinion!

Thanks for your question. I usually prefer placement of breast implants in a "dual plane", the upper part of which is under the muscle and the lower part is just under breast tissue. This gives the most natural look, avoids a shelf like appearance to the implant (seeing the upper edge of the implant), and reduces the risk of hardening around the implant (capsular contracture).  You appear to have very little breast tissue from these photos so placement of your implants above the muscle may compromise the aesthetic results. After 30 plus years performing aesthetic plastic surgery, that is my best advice. However, nothing replaces a personal consultation with a board certified plastic surgeon. Best of luck!Richard Chaffoo, MD, FACS, FICSTriple Board Certified Plastic Surgeon

Hello Addams22 and thank you for your question. You
would be a good candidate for a breast augmentation. Please keep in mind that a breast implant is like a ball and it has a certain
diameter. Your base width
on each side of your chest will determine "how big of a ball" or what
diameter implant you can reliably go up to with a socially acceptable
cosmetic outcome. The implant will "augment" or increase the size of
your breasts to an amount acceptable to you and your surgeon. As for implant placement, I understand that you are very active, but I have many patients who are hardcore fitness enthusiasts and I have them back to their normal routine within a month even after breast augmentation under the muscle.  You appear very lean, and long-term, with larger implants, your tissue will thin and you may suffer from implant rippling, malposition, etc as you do not have a lot of soft tissue support over the muscle and then down the line your fitness routine could be disturbed with the need for revision surgery; don't forget the downtime needed to have future surgery and also the costs of the procedure and also time off from work. In my opinion, going under the muscle has
many benefits such as decreasing your chances for rippling, decreasing
your chances for capsular contracture, increasing your chances for
greater longevity, and also a more natural look. Dual Plane is where
the muscle is separated from the gland inferiorly and allows the top of
the implant to be more under the muscle where inferiorly towards your
feet it mainly under the gland and there is no muscle. The benefits of
dual plane are basically the same as subpectoral, but allow for better
lower pole expansion and slight nipple elevation for cases of truly mild
ptosis or slightly saggy breasts. There are many ways to perform plastic surgery and if you
are not certain with the recommendations made by the surgeon whom you
have seen, I think you should trust your intuition and I would encourage
you to seek
a second opinion via consultation with a board certified plastic surgeon
with expertise in
aesthetic breast surgery. I
hope this helps answer your question!Sincerely,Dr. Sean Kelishadi

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.

Unless you participate in muscle/fitness competitions, I do not recommend that you consider going over the muscle; it will be associated with rippling and increase risk of capsular contracture, and increase distortion of your glandular tissues with imaging studies later in life. Please reconsider going under the muscle.

On a petite frame, implant visibility increases significantly.  When an implant >350cc is placed above the muscle, it is almost always visible, and you will notice rippling.  Highly cohesive silicone textured (gummy bear) implants would likely have fewer complications, if you want the implants placed above the muscle.