Recommendations, please: above/below muscle, size, style, shape of implants? (Photo)

Question

62 yo healthy at 5'9" with stable weight of 190# seeking upper pole fullness. Bilateral Mastopexy 20+ years ago and nipple still above crease. Seeking advice re above/below muscle, size, style, shape of implants.

Zoran Potparic, MD · Answer

Althought lift and augmentation would give you better result, augmentation only may be sufficient to address upper pole fulness. Implant in the range of 300 ml, moderate profile, subgladular, would be my suggestion. That will give you 1.5 cup sizes up!. Good luck.

Randal Haworth, MD, FACS · Answer

It's great that you're seeking advice on the best approach for your breast augmentation. As every individual is unique, it's important to have a thorough consultation with a board-certified plastic surgeon who can help you determine the best options based on your specific needs and goals.

During the consultation, the surgeon will consider various factors such as your breast anatomy, skin elasticity, and the amount of breast tissue present to determine whether the implant should be placed above or below the muscle. They will also help you choose the appropriate size, shape, and style of implants based on your desired outcome.

In terms of achieving upper pole fullness, there are various implant shapes that can help achieve this, such as high profile or moderate profile plus implants. These implants can create a more rounded and lifted appearance to the breast.

Your surgeon may also recommend a breast lift (mastopexy) in conjunction with the augmentation to achieve the best results. This can help lift the nipple position and improve the overall shape of the breasts.

It's important to discuss all of your options and any concerns you may have with your surgeon before proceeding with the surgery. They can provide you with a comprehensive treatment plan tailored to your individual needs and help you achieve the best possible outcome.

I hope this helps,
best of luck !

Daniel Barrett, MD · Answer

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

Gary M. Horndeski, MD · Answer

Your breasts are still low on the chest wall. The technique I recommend is The Bellesoma Method. This will 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 and nipple sensation (in 95%) is maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

You appear to be a good candidate for breast augmentation .  A silicone implant placed beneath the muscle can give you more upper pole fullness while maintaining a natural look and feel.  Depending on your surgical goals, you may consider a lift as well.  I've included a video on implant selection that I hope you find helpful.

Connie Hiers, MD, FACS · Answer

Although your nipples are in a good position, your breasts have sagged and will need to be lifted again. Implants can be added behind the muscle for better upper breast fullness and support the weight of the implant.  Do notice that your natural breast bases sit somewhat low on your chest and the bases cannot be moved.  I would meet with a board certified plastic surgeon, be measured and examined, and try on a variety of sizes to see what you like. I do not recommend going large for you will just sag again from the weight. As we age, our tissue holds weight less well and things sag.

Ralph M. Rosato, MD · Answer

Size is a personal choice for each patient. Your surgeon can help you understand what is possible for showing you photos of patient that look like you.  A PE exam is indicated to determine the best placement above or below the muscle. There are pro's and con's of each operation. One operation does not fit all.

Douglas Taranow, DO, FACOS · Answer

Thanks for your question and proper photos. While your nipple is above the crease, you do have some breast tissue hanging below.  If not interested in any small lift, I would suggest subglandular placement.  The shape and size of the implant would depend on your desires and a physical exam.

Recommendations, please: above/below muscle, size, style, shape of implants? (Photo)

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