Is over the muscle breast augmentation with gel or saline better?

Question

Is over the muscle breast augmentation with gel or saline better? I just had a consultation yesterday and he suggested over the muscle implants as I have larger breasts and they are droopy? I havent been able to find alot of pictures of over the muscle implants

Finny George, MD · Answer

Hi, thank you for sharing your question. Implants placed over the muscle can give excellent results in the right patient. A small amount of breast drooping can be corrected with this method. Photos would be helpful to determine if this is a good option for you.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to breast revision surgery.  The biggest mistake I see by surgeons and patients is getting implants placed on top of the muscle.  Almost always, the implants drop with time and look horrible after just a few years.  The idea that you can use an implant on top of the muscle and feel the skin envelope is flawed.  By placing a large heavy object in skin that is already drooping and stretch results in even more stretching and a droopier breast.  I have seen this way too frequently and wrote a paper entitled " Poor practice".  If you need a lift, then you need a lift, it is just that simple.  Best wishes to you.

Ricardo Vega, MD · Answer

Hello, thank you for your inquiry! Gummy bear gel silicone implants are better than saline and will last longer. I recommend my patients gummy bear implants, over the muslce depends on the patients breast. I recommend seeking a board certified plastic surgeon for an in person evaluation to discuss further details. Best of luck

Sean T. Lille, MD · Answer

I rarely recommend implants being placed over the muscle to my patients because the weight of the implant just adds to the weight of the breast tissue causing the droop. You didn't mention why you want an implant if you already have large droopy breasts but my guess would be for the shape above the nipple. Implants placed above the muscle have a much higher incidence of capsular contracture, which takes you back to surgery to fix. Saline implants are a firmer scaffold for holding the skin up and don't have to be replaced until there is something wrong with them (deflation or other complication) Silicone implants are less firm (more teardrop shape) and are recommended to be replaced every 10-13 years. Please seek several opinions.

Daniel Barrett, MD · Answer

Dear JFRAZ8288,
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

James Knoetgen, III, MD · Answer

The choice between over-the-muscle (subglandular) placement and under-the-muscle (submuscular) placement for breast augmentation depends on various factors, including individual anatomy and personal preferences. Gel (silicone) and saline implants also have their own considerations. Over-the-muscle (Subglandular) May result in a quicker recovery Can provide a more natural movement of the breasts  May be suitable for those with sufficient natural breast tissueUnder-the-muscle (Submuscular) May offer a more natural look, especially for those with minimal natural breast tissue Could provide better implant coverage, reducing the risk of visible implant edges May interfere less with mammogramsGel (Silicone) vs Saline implants Gel implants often feel more natural Saline implants may have a firmer feel and are usually less expensive In the case of implant rupture, the leakage differs – silicone gel may be less noticeable than salineUltimately, the best choice depends on your specific goals, body type, and the recommendations of a skilled plastic surgeon who can assess your individual situation. They can guide you based on your desired outcome, existing anatomy, and potential risks and benefits.

Camille Cash, MD · Answer

If you have drooping breasts you will want to consider a lift.  Neither over the muscle nor under the muscle implants are able to give the same result as a lift.  As far as selecting saline or silicone, there are benefits and drawbacks to each.  I've included a video that summarizes this that I hope you find helpful.

Connie Hiers, MD, FACS · Answer

If you are sagging, get a lift. Implants will not correct for sagging. Going over the muscle, chose gel implants to avoid seeing ripples.

Jesus Eduardo Chung Gallardo, MD · Answer

Thanks for the question. If your breast is droopy, the answer is not implants Over the muscle. May be you need a breast lift. About gel or saline, gel is firmer than saline. But the real point is to know, if you need a breast lift or not, no matter gel or saline

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

Breast implants placed on top of the chest muscle or more likely to be visible, the natural rounded shape, and at greater risk for capsular contracture or hardening due to scar tissue around the implant.

Subpectoral breast augmentation conceals the implant more effectively and has a lower incidence of capsular contracture or scar tissue around the implant.

One problem with saline implants is the possibility of visible rippling which can be seen underneath the skin especially in implants placed on top of the muscle.

Is over the muscle breast augmentation with gel or saline better?

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