Getting 600cc HP gummy bear implant under muscle with a lift. Does moving the implants under the muscle help lift them higher?

Question

I have 400cc moderate silicone implants over the muscle. I will be having surgury 5/31/18. We decided to choose 600cc High profile gummy bear implant under muscle with a lift. Will this help me achieve a much fuller beast on top with closer together cleavage and does moving the implants under the muscle help lift the breast higher? Is 600cc larger enough. My existing breast is a large B with out implants.

Daniel Barrett, MD · Answer

Dear jgubba1,I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

At 400 cc, your
breasts are too low and lateral.  The
additional weight of 600 cc implants will make your situation worse, despite
the lift.  Your skin envelope does not
have the mechanical strength to hold up 600 cc implants, which weigh about 1 ½
lbs each.  I recommend explantation using
The Bellesoma Method.  This will remove
your implants, reshape your breast tissue creating upper pole fullness without
implants, elevate them higher on the chest wall and more medial to increase
your cleavage.  Vertical scars are
avoided, nipple sensation and the ability to breast feed are maintained, if not
injured during your previous surgery.  At
the same time or later, fat transfers can be performed if additional volume is
desired.    Best Wishes,Gary Horndeski, M.D.

Sean Kelishadi, MD · Answer

Hello and thank you for your question. Whenever possible, I like to place implants under the muscle to help decrease bottoming out, rippling, and also risks of future capsular contracture. Not only do I think this is a more durable technique for a leaner person like yourself, but I find that the implant being placed under the muscle gives a more natural slope to the breast. As far as what "lifts the breasts higher," getting a breast lift and the profile of the implants you get determines this more so than whether or not the implants are on top of the muscle or not. Going from 400 to 600cc's will definitely give you at least a cup size more of volume, and doing the breast lift will further help make you look perkier with nicer cleavage. I hope this helps and please make sure to seek the expertise of a board certified plastic surgeon with expertise in revision breast surgery for your optimal outcome.Sincerely,Dr. Sean Kelishadi

Tom J. Pousti, MD · Answer

Yes, generally speaking, breast implants placed in the sub muscular position tend to "sit" higher on the patient's chest wall.   Besides breast implant positioning, there are many variables that come into play when it comes to the final aesthetic outcome achieved with this type of revisionary breast surgery.***Given your concerns, it is definitely worth spending more time (preferably prior to the date of surgery) with your plastic surgeon to discuss further.  One question that might be helpful to you: will you be more disappointed if you are slightly too small or slightly too big?  It will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
 Generally speaking, the best online advice I can give to ladies who are considering  revisionary breast augmentation surgery ( regarding breast implant 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. For example, I have found that the use of words such as “natural” or "C or D cup" or "much fuller breast" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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 helps. Best wishes for an outcome that you will be very pleased with.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photos and question but an examination is really needed.  That said from the photos alone you do not appear to need a lift but going larger and submuscular should give more upper pole fullnessDr Corbin

Edward J. Domanskis, MD (in memoriam) · Answer

My specialty id XL breast implanbts and those patients that want the round high fake look. I have noticed that intially that under the muscle placement of breast implants does give more fullness above but as tiume goes by, it actually in my observations causes the bresast to become less full above. I think that that is bvecause the muscle keeps contracting and "drives" the implant down!

Getting 600cc HP gummy bear implant under muscle with a lift. Does moving the implants under the muscle help lift them higher?

Answers (6)

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