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

Question

I’m 5’2 120lb I have to have saline because of my age, and my doctor wants to go above the muscle I’m a 34A or 32B right now hoping to get to D,DD I’m a bit worried doing both saline and over the muscle, will I be okay doing this

Daniel Barrett, MD · Answer

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

Gerald Minniti, MD, FACS · Answer

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.

John L. Burns Jr., MD · Answer

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

Adam Bauermeister, MD · Answer

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

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery, and I have been in practice over 28 years. I have a whole gallery titled " chronic changes of implants placed on top of the muscle". Over the years, I see very few results that are attractive with time when placing implants on top of the muscle. In nearly all patients, eventually there is slide down the chest wall and a poor outcome. The worst situation I see commonly is placing saline implants on top of the muscle.  In almost everyone of these, there is significant wrinkling.  I would definitely choose a different doctor if this is the suggestion that he or she has made for you. Listen to someone who has experience, place them under the muscle. Best wishes to you.

Justin Booth, MD · Answer

Thank you for this great question!
One of the issue with saline implants is that they tend to stretch out the skin more than silicone because they are not form-stable. Another issue with saline is rippling, especially in patients without a lot of breast tissue. Implant palpability/visibility can also be an issue when going over the muscle in patients without much native breast tissue. I would recommend consulting with several board certified plastic surgeons in your area to make the most informed decision possible.
Hope this helps! Best of luck!
Justin Booth MD FACSAustin Plastic Surgery Institute Austin, TX

Camille Cash, MD · Answer

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.

Connie Hiers, MD, FACS · Answer

You did not post photos, so I cannot be specific. However, most women do best with saline implants placed behind the muscle to avoid seeing the edges.

Jeffrey K. Scott, MD · Answer

Yes, I would also be concerned about saline implants as well and also be concerned about implants being located on top of the muscles. Most plastic surgeons can get around the saline issue and justify more current silicone implants. The risk of breast implant capsular contracture is greater when implants are located on top of the pectorals muscles as apposed to being located into the “dual plane” submuscular pockets and rippling of the implant shell is more prominent when placed on top of the muscles. You may also be better off recieving slightly smaller implants base on your smaller frame. Best of luck!

Mats Hagstrom, MD (license on probation) · Answer

It’s not appropriate for us to guide you through breast augmentation surgery or to give you suggestions about what implants to use. That is something you need to discuss with your provider.
If you’ve had an in person consultation and are still left with questions that I suggest you follow up with your provider for another meeting before the date of surgery.
 I don’t know what age has to do with getting silicone implants.
There are generally three variables that determine breast augmentation outcomes. The first is the patient candidacy for the procedure. The second is the choice of implant in regards to size, shape and type. The third is the technical ability to placing a plant in anatomic correct position.
Best,
Mats Hagstrom, MD

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

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