You hit the nail on the head. Glad to see you have done your homework. Saline implants are perfectly safe and have never been removed for the marketplace. Placing the implant under the muscle gives a more natural look to the upper portion of the breast. Moreover, it is safer for you to have them placed under the muscle. That having been said, it does hurt a little more as your chest muscles will be stretched and quite tender for a few days as you accommodate to your new breast volume. Excellent choice. I wish you well.
Saline Breast Implants: Natural contour and Improved shape with submuscular implants
Breast implants can be placed in the submuscular or subglandular plane.
A natural contour and feel is dependent on the following breast principles:
- Symmetry of the breasts
- Position of the nipple areola
- Shape of the native breast prior to implantation
- Contour of the breast prior to implantation
- Quality of the skin
- Amount of breast parenchyma
- Density of breast parenchyma
- Technique of implantation
- Saline or silicone implants
Saline implants can feel very natural depending on the quality of the skin, size of the implant relative to the breast, location of the implant, and density of breast parenchyma.
Saline Breast Implants can Look and Feel Natural - Look at the Photos!
My breast augmnetation gallery includes more than 90 of my breast augmmetation patients with views from three different perspectives. A number of the images are women with saline breast implants. See link below.
Having practiced plastic surgery in the 'breast augmentation capital of the world' (Los Angeles), I have developed some fairly strong opinions about this operation. In thinking about breast augmentation surgery, I believe that the most important question for a prospective patient to ask themselves is this: Am I seeking a natural-appearing result? When the goal of this operation is a natural breast enhancement, the results can be absolutely beautiful.
However, if the goal is to create a breast profile which is out of proportion to a woman's body, the results (by definition) never appear natural, and these patients not infrequently end up having a series of operations to address problems with their abnormal appearance. For that reason, I encourage women who are investigating breast augmentation to consider a breast implant size that will help them 'fill out clothes better' and improve the overall proportions of their body, not one that makes them look like "the gal with the boob job".
Quite a number of my breast augmentation patients are moms. After one or more pregnancies, most women experience a loss of breast volume combined with some 'stretching out' of the breast skin. In many of these patients, a breast implant of moderate size will restore a very pleasing breast contour. These patients are NOT looking to raise eyebrows at work or around the neighborhood - they just want to throw their padded bras away, and to feel better about their appearance in private.
When there is laxity of the breast skin that makes the breasts appear somewhat droopy, the addition of a breast implant of moderate size can 'fill up' the excess skin and create the appearance of a breast lift (although this is not truly a breast lift or 'mastopexy'). This is often a situation that exists after pregnancy and lactation, but I also see quite a number of patients with significant breast skin laxity who have never been pregnant. In patients with more advanced drooping of the breasts, particularly when the nipples are pointing downwards instead of slightly upwards, a mastopexy (breast lift) needs to be combined with the breast augmentation surgery to tighten the skin envelope of the breasts, in order to produce a result that is truly youthful and aesthetically ideal. This procedure is called an augmentation mastopexy, and the results of this operation can be dramatic and absolutely transforming. It is discussed in greater detail as the next topic under the heading 'Body Contouring Surgery'.
Attention to detail
While the issue of 'over' or 'under' the pectoralis major muscle receives a great deal of attention, even more important than breast implant position relative to this muscle is implant position vertically and horizontally on the chest wall. In many patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola, and in order to prevent the appearance of excessive upper pole fullness.
In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance.
The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Excessive lateral dissection of the implant pockets will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. Inadequate lateral dissection, on the other hand, will result in an augmentation with an abnormal 'side by side' appearance. As it is lateral projection of the breasts beyond the lateral limit of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an 'hourglass figure', careful attention must be paid to ensure that lateral breast projection is not inadequate.
Another consideration is that the breast implant base diameter must match the existing anatomic limits of the breast preoperatively and the breadth of the anterior chest in general. Obviously, a given implant volume and diameter that works well for a small-framed patient that is 5'3" will be inadequate for a large-framed patient that is 5'10". Careful evaluation of all of these issues is necessary if the ultimate goal of the surgery is a natural-appearing breast augmentation.
Choosing the breast implant size
In consultations I listen carefully to each patient to ensure that I clearly understand their goals for breast augmentation surgery. Based on that discussion, and on the physical examination, I go into surgery knowing what the ideal volume should be within two or three breast implant sizes. However, the patient and I do not decide on one particular size prior to surgery. There is absolutely no way, in my opinion, to know exactly what size implant is the ideal size for a particular patient in advance of creating the implant pockets in the operating room. For that reason I keep a wide range of implant sizes on hand in the surgery center.
If natural is the goal, then the way to get the size right is to 'try out' different implant volumes in the operating room. Once the implant pockets have been created, I place a 'sizer' in one implant pocket and have the upper half of the O.R. table raised so that the patient is in an upright 'sitting' position (chest fully upright). The sizer is then inflated gradually to the point that the breasts appear full, but not unnaturally so. In this manner the exact volume that produces a full but natural breast profile is determined.
For any patient there is obviously a range of implant volumes that would be considered natural. While one patient may seek an augmentation that is 'the small side of natural', another may be interested in something that is more on 'the large side of natural'. By using breast implant sizers to determine exactly what breast profile a given implant volume produces in the O.R., I am able to provide patients with the closest possible approximation of their preoperative goals.
Saline breast implants of a moderate (and in my opinion, appropriate) volume look and feel natural. The implant sizes I most commonly use blend in nicely with existing breast tissue, and patient satisfaction is high. In the ten years I have been using saline implants I have yet to have a patient with saline breast implants return to say "I'm not happy with these, take them out and put silicone gel implants in their place."
Saline implants usually look and feel natural
The result of breast implant surgery has something to do with the patient and her desires regarding size and something to do with the surgeon and his/her technique. If you have relatively little breast/chest muscle tissue and want really large breasts, you are not going to look (or feel) so natural. How natural things look has alot to do with how much of your tissue covers those implants. Think "under the muscle" implants to get that tissue working for you.
If you are more interested in a natural appearance than a particular size, then by all means tell your surgeon. Many surgeons are so used to hearing complaints that the implants are not big enough, that they put large implants in almost by reflex.
The key is to have a good dialogue with your surgeon and to choose a good one. In this case most patients are quite happy.
It depends on your body type
In my practice, 80% of patients select gel implants because the "feel" of the implant is of paramount importance. 20% go with saline because they believe it is "safer" for them. So, if despite all the evaluations by the FDA, you don't feel comfortable with gel, you should go with saline recognizing that they won't (even under the muscle) feel as natural as gel. It becomes a matter of what your personal priorities are.
If you are thin and have minimal breast tissue, the palpable differences between the gel and saline are even more notable. This is especially true when a saline patient (even under the muscle) leans forward and feels the outside edge of the implant. They will almost always feel and or see wrinkles and ripples there. If that would bother you, go with gel.
Saline Implants Have the Potential to Look & Feel Natural Following Breast Augmentation
Saline implants have the potential to look and feel natural following breast augmentation surgery. This requires adequate soft tissue coverage of the implant and the selection of an appropriately sized implant.
When adequate soft tissue coverage is present, the breast looks and feels natural. When soft tissue coverage is inadequate, the breast may not feel normal and rippling may be present.
Adequate soft tissue coverage is more likely if the patient has a moderate amount of her own breast tissue and the implants are placed underneath the muscle. Under these circumstances, the breasts are more likely to feel normal and also have less rippling. The use of large implants would have the opposite effect because the soft tissue coverage would be inadequate.
In patients who have minimal breast tissue and a thin body habitus, an artificial feel and rippling may be unavoidable. In this situation, silicone implants in a submuscular position may be necessary to obtain a natural look and feel.
A consultation with a board-certified plastic surgeon will help determine the appropriate style and size of breast implant. In your situation, it would not be unreasonable to expect a natural feel and look with saline implants. With a reasonable starting breast volume, a moderate-sized saline implant in a submuscular position should give you what you’re looking for.
It is my experience that saline implants will look great but typically feel less natural, especially as time goes by. Saline allows me to correct minor asymmetry of the breasts and place through smaller incision but usually some rippling of the lower lateral breast. I would suggest always placing saline implants under the muscle in attempt to soften the feel and look.
Do Saline Breast Implants Look and Feel Natural?
Saline implants can present as very natural appearing augmented breasts when placed under the muscle but they do not feel as natural as silicone implants. They are a good choice for patients either scared of silicone or for economic reasons.
Saline breast implants, especially when place under the pec muscle, can look and feel as good as silicone implants. With saline implants you gain adjustability and save some cost. If you . If you have little breast tissue,you need to be careful to choose a midest implant so to minimize visible rippling or wrinkling.
Just to be clear silicone implant are and have always been safe. The studies have looked at hundreds of thousands of women comparing those with silicone implants and those without and there is no difference in disease prevalence between the two groups.
Silicone will always feel more natural. However, initially saline will feel firm but over time they and the breast tissue will soften. After 6 months they will feel very natural. If you were an A cup I would strongly recommend silicone but at a B cup you probably have enough overlying breast tissue to give the overall result a very natural feel.