Will a 400 CC saline over the muscle implant be okay on my frame?

Dear Trustworthy158012,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

1. FDA approval for silicone gel implants of 22 years and older does NOT mean younger women can't get silicone gel implants. It's called 'off label' use and it's done all the time in many fields of medicine. 2. There is no reason to go over the muscle, ever. You stand to have a much higher chance of complications like rippling, implant palpability and capsular contracture when going over the muscle. Please, this doctor will not do what's right for you. Find a true expert near you.

If you are unsure about the implant selection and placement that was recommended it is best to visit with another board certified plastic surgeon near you to get a second opinion. Though I do both, I typically place implants beneath the muscle as it gives a more natural look and has a lower occurrence of capsular contracture. Many surgeons have sample implants available that you can "try on" to get an idea of how you may look after surgery. This may help guide you in selecting the size right for you.

Instead of sub glandular you should consider subfascial which has many of the benefits of a SubMuscular augmentation without the animation deformity.

Hello,
Without reviewing your history and performing an exam, I can't provide accurate personalized recommendations. However, general recommendations for the implant pocket location is determined by several factors. One factor is how much breast tissue you have. If you have less than 2 cm of soft tissue on pinch of the upper breast pole, it is typically recommended to have the implant placed below the muscle in an attempt to avoid overt implant show, unnatural contour, and implant rippling. Based off the provided information, I would personally choose to place the implant below the muscle (biplanar pocket position) to help avoid the above potential issues. I hope this helps.
Best regards, Adam Bauermeister, MD