Under Muscle or Over? Moderate-plus or High Profile? Which Silicone Inplant BEST Fits my Body for a Natural "D" Cup Look? (photo

I'm 5'5 weigh 170 lbs. I wear a 36B and am looking to achieve a "D" natural cup that will not make me look wider and too "ball-ly". I've been told by two doctors in the US a silicone "moderate-plus", under the muscle best fits at 450ccs. Two surgeons in Mexicali, Mx recommended a silicone "high-profile" OVER-the-muscle implant at either 410-450. What is the best choice for me to achieve a natural look? Please help!

Doctor Answers 10

Implant Selection Process

In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.
Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 82 reviews

Natural look

Placing a silicone gel implant just behind the breast, not muscle, will give a more natural placement, movement and look. However, placing the implant behind the muscle will give a more smooth contour of your upper breast, and help avoid the edge. Placing the implant behind the muscle may cause the breast to sit farther apart. High profile implants place more strain on your lower tissue and can with time cause that tissue to thin.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Measurements and more info needed to make better assessment

Have you tried on sizers? This can help you get a better idea of how you may look with certain implants.

I generally help patients choose implant size and placement by taking into consideration their original body contour measurements (including height, weight, breast width, breast height and the distance that exists between the nipple and breast fold) alongside desired cup size. This helps achieve a proportional body enhancement that meets the patient's needs without resulting in an unnatural appearance. Patients often report less pre-surgery hesitation as well, since the technique helps with selecting the right implant size and style to achieve the most natural and pleasing result.  

Implant placement

The size range you mention, 400 to 450 is reasonable, but I always recommend going under the muscle.  There is a lower incidence of capsular contracture under the muscle.  As far as the profile, I prefer moderate plus with silicone and high profile with saline.  High profile saline implants tends to ripple less.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 24 reviews

Simultaneous lift is best

The best technique for you is Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to decrease the wide separation you have currently.  Through the same incision, implants can be placed.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable long term, less likely to ripple or have complications needing revision.  The profile of the implant is irrelevant in the retro-pectoral position since the muscle compresses it.  At size 36 B each 200 cc’s of implant corresponds to 1 cup size change.  400 cc’s would take you up approximately to a D. 


Best Wishes,


Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 208 reviews

Implant Selection #breastimplants

Thank you for your questions. There are many to address. So the issue of under the muscle or over is a lengthy one that your surgeon should go over with you. In this forum there is just not enough time. That decision depends a lot on your physical breast qualities and your physical activity. I go mostly under the muscle except in active athletes doing lots of pectoralis work. I know people who only go above the muscle. There are pros and cons to each and your surgeon can explain them. The profile implant you get also depends on the base diameter measurement of your breast. A surgeon should stick to an implant that fits the footprint of your breast as you would only buy a shoe that fits your foot. Once the diameter measurement has been established you then need to try on implants of different profiles but that are the base diameter of your breast and decide which one gives you the look that you desire. I caution patients to not focus on a cup size because every bra is different and will tell you a different cup size. Focus on conveying what look you are going for to your surgeon. 

Richard J. Brown, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 40 reviews

Under Muscle or Over? Moderate-plus or High Profile? Which Silicone Inplant BEST Fits my Body for a Natural "D" Cup Look?

                    450 cc is not an unreasonable size, but trying on sizers in the office will give you the best idea.  Picking the profile or style should be easily navigated by your plastic surgeon.  Going under the muscle would give a more natural look.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Natural look and implants

Choosing the best implant for you is really best done in the office after a thorough exam and a discussion of your goals. It is difficult to say without doing the above.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast Implant and pocket selection

In order to help you with this difficult decision one has to know the 3D dimension of your breast.   It is a common misunderstanding that body weight, height or bra size guide implant selection.  You should work closely with the plastic surgeon of your choice to make these assessments.  If available in your area, consider a 3D imaging system that can help to simulate various implants sizes which would facilitate your implant selection.   Under or over the muscle is a controversial issue but simply put, it would depend on the thickness and quality of your breast tissue;  thin breast requires placement of the implant under the muscle.

Under Muscle or Over? Moderate-plus or High Profile?

I think most surgeons in the US feel, correctly, that under the muscle is the better placement of breast implants for almost all patients. The choice of profile would depend upon the measured width of your breast. As a guideline, implants wider that the patients breast look less natural. From the appearance but without measurements, I suspect a moderate plus implant to be too wide, and that a high profile would be the better choice.

Your breasts are rather widely separated, and that will still be true with implants, and the appearance of separation may be greater at a larger size. 

I also wonder whether or not you should be discussing the pros and cons of having a breast lift at the same time. Your areolas are low, and may well appear too low at a larger size. 

Thanks for your question, all the best. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.