Size, technique and shape - is 300cc over the muscle right for me? (Photo)

Question

I had a breast augmentation and the surgeon told me CPG 321 300cc implants over the muscle and I am wondering is that the right choice for my breasts. He said I have enough tissue to go over the muscle. Any surgeon feedback appreciated!

Ram Kalus, MD, FACS · Answer

Thank you for your question and photos. An examination in person would be required to properly evaluate you but from your photos you appear to have very pretty and symmetrical breasts. Based on those alone I would carefully consider why it is that you are seeking a breast augmentation . An experienced board certified plastic surgeon should be able to advise you, but please use photos of “favorites” to communicate your wishes, as opposed to words such as “natural” or “not too big”, which can be misinterpreted. Best of luck to you.

Daniel Barrett, MD · Answer

Dear Khloe14109,
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

Brian Bassiri-Tehrani, MD · Answer

That is a great question. Every patient has a different preference in terms of size and how big they want to be. For example, some people prefer to have a subtle and natural result, whereas others prefer to have an "augmented" look where it is obvious breast implants are in place. Sometimes, patients want to have implants that are too big for their frame. 
In order to determine the best size, certain measurements help guide surgeons pick the best implant for patients. Based on the limited photographs, however, it seems as though 300cc would appropriate, depending on what size you ultimately want to be.
Going on top of the muscle depends on how much breast tissue is present over the muscle. This is determined by examining the breast by a "pinch test" (literally pinch the skin on the breasts) to feel how much tissue is present. This makes sure the implant will not be too obvious and show rippling (creases in the implant itself that shows on the skin). Sometimes, a firmer (or more cohesive) implant can be used if the implant is going to be placed above the muscle to prevent the risk of rippling. The implant your surgeon used is a more cohesive type of implant, and your surgeon said you have enough tissue above your muscle, making the technique choice acceptable.
One of the risks of going above the muscle is that there is a higher rate of capsular contracture. This is when scar tissue surrounding the breast tissue causes pain and firmness in your breasts. The rate of capsular contracture is lower when implants are placed under the muscle.
One of the benefits of going above the muscle is that there is no animation deformity (movement of the breast implant with movement/flexion of your chest (pectoralis major) muscles).
Going above or below the muscle depends on each individual patient's characteristics and skin quality, which can only be assessed in person. The most important thing is to have an informed discussion with your surgeon who will help you make the right decision.

Zoran Potparic, MD · Answer

Based on these photos, you have enough  breast tissue to consider both subglandular (on top) and submuscular (under the muscle) implant placement. Implant volume of 300 ml will give you 1.5 to 2 cup sizes up. Hope this helps. Good luck.

Farhad Rafizadeh, MD · Answer

You have the ideal shape breast for breast augmentation. It is hard to tell from the selfy picture if they are symmetric. 300 cc breast implant could be the right size if your base diameter is between 11 and 12 cm. The important thing is to not violate your lateral breast folds and infra mammary folds. You don’t want to ruin a perfect  breast shape with implants. Make sure you don’t go too big. You could go over the muscle to avoid animation deformities. The important thing is to maintain the shape of your breast and this is why the size of the implants and the dissection has to be perfect. Good luck.

Alireza Najafian, MD · Answer

From the photos, looks like you do have enough tissue for implant placement above the muscle. I almost always do my breast augmentations in the subfascial plane which is above the muscle and under the breast tissue and rarely go under the muscle for a variety of reasons: under the muscle placement has more difficult recovery, it affects the function of pec muscle specially in physically active patients, causes animation deformity and in long term has risk of waterfall deformity. In terms of size, the main factor is your breast width, you don’t want to choose an implant that is wider or smaller that your breast width, then we can choose different projections within that width to help patients meet their goals. So, I would say if the width matched your exam, it is a reasonable size.

Connie Hiers, MD, FACS · Answer

Just based on photos only, I would suggest placing the implants behind the muscle or behind the fascia instead. Please discuss this with your surgeon.

Douglas Taranow, DO, FACOS · Answer

There is no right or wrong  as every surgeon had their preferred implants and technique for insertion.
I fell you are a perfect candidate for a transaxillary (armpit, no breast scar) submuscular (under the muscle-my personal preference) silicone breast augmentation.  The 300cc is fine depending on which wish pics you show your surgeon.
Best wishes and good luck with your procedure.
Dr. Taranow

Camille Cash, MD · Answer

From your photos you appear to be a good candidate for breast augmentation.  It appears you have adequate tissue to have the implants placed over the muscle.  A discussion of your surgical goals and an exam is needed to know if 300cc is right for you, but conceptually it would give you a nice enhancement without being too large.

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

Thank you for your question.

First you have perfect breast anatomy and is very important that if you proceed with breast augmentation tyou be sure that nothing is done which can alter the appearance of your breasts in a negative way.

Years of research have proven that placing the implants underneath the chest muscle is a safer more effective technique for breast augmentation.  Placing the implant underneath the muscle reduces the risk of capsular contracture or hardening and gives you a more natural soft appearance and feel.

I am sure you have seen patients who have had breast implants and have round balls that look like they are pasted onto their chest.  When you see this appearance it means either the patient has capsular contracture or hardening or breast implants on top of the muscle which have compressed and reduce the size of the breast gland t tissue over time.

Before you consider having breast implants on top of the muscle please do a literature search and read about the "no touch technique for breast augmentation."  This technique is the modern "best" method for breast augmentation available today.

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