Are over the muscle implants the right choice for me? 565cc or 595cc HP over the muscle (subglandular) implants (Photo)

Thank you for your question. A large portion of my practice is dedicated to revisionary breast surgery. I do see many patients who are fooled into thinking that they can have a implant placed on top of the muscle, and that this will fill up the breast implant envelope. This only works if we live on Mars. Imagine that you are already drooping and now place a weight on top of your muscle. The inevitable event will be that your breast will continue to droop. You or exactly this case scenario. If you placed her implants on top your muscle you will be very disappointed with the result in the next 6-8 months. I have a whole revisionary breast practice based on this short sided thinking. On the other hand, you are an excellent candidate for a dual plane breast augmentation and mastopexy (lift). Best wishes to you.

Good evening,
I am a big fan of under the muscle- they look better, last longer, have less CC, and overall don't sag as fast. The problem with overs for you is that a year from now they will be much lower because your skin looks very stretchy, and your CC risk is double over the muscle.

Implants alone will not solve your problem. 565 cc or 595 cc implants are much too large, will not fit under the muscle and will weigh down the breasts. The technique I recommend is a lift using 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, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

There are several advantages to going under the muscle. You will typically have a more natural appearance to the upper part of your breast. The action of your muscle will help massage the implant and keep the scar tissue capsule soft. The muscle protects the implant from the natural bacteria in your breast to decrease the risk of infection and capsular contracture. Going over the muscle does allow for more “lift” but if a “dual plane” approach is taken you can pair the advantages of both approaches.
My patients prefer to try on implant sizers under garments they typically wear (workout tops, bikini, tight sweater, low cut dress) to determine if they fit as expected and help allay some of their trepidation associated with this decision. I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy. It's unlikely that you will notice a difference in increments less than 100 (565cc versus 595cc is only 30cc).

You are right, over the muscle puts you at not only higher risk of capsular contracture and implant visibility and rippling, but also implant dropout due to tissue stretch/loss of support from deep structures (the pec major muscle). Further, your surgeon has likely made this recommendation because of your breast ptosis, and the need for a breast lift. Although the initial outcome might appear ok, it won’t be long before you realize that you have not escaped the need for a lift, and are now exposed to all the aforementioned complications. I would strongly advise you to rethink this plan. If you fear the scars of a breast lift, than I encourage you to do nothing rather than to do the wrong thing. Finally, you have to ask yourself the motive of your surgeon to recommend this, and not the most evidence based best surgery: an implant placed into the subpectoral position and a formal breast lift. It’s either because he fears your disapproval because of scars or extra cost, or he does not have confidence in his ability to perform a breast lift well (a much more difficult procedure than an implant based augmentation), or he simply lacks the training or ability.

Hi. Your concerns are correct! If you have implants OTM, there is a higher incidence of contracture. But more importantly, the weight of the implants will cause your breasts to sag more rapidly over time. In a few years, you won’t be happy with the stretching and sagging that has occurred. Talk to your surgeon about these issues prior to the day of the surgery. Best of luck!

Dear Calm273002,
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

You clearly need a breast lift performed. The surgeon may think that implants in front of the muscle will help with a lift, but they won’t. I suggest getting another opinion. If you don’t want a lift you are better off not getting a lift at all

There is one draw back for placing implants behind the muscle and that is animation deformity. This is when you contract your pectoralis muscle and the implant moves for that instance and then the implant comes back and looks normal. Over time if you are working out your muscle the implant can displace laterally which is why I tell all my patients to give up working out their pectoralis muscle after breast augmentation. When the implants are placed in front of the muscle the issues that arise are higher in number and more prominent: capsular contracture, rippling, premature "sag" of the skin, etc.

Dual plane technique which would need to be used on you then to give you the benefits of OTM with giving a nice shape to the lower pole but still give you protection by having the upper 2/3 of the implant covered by the muscle. Therefore going over the muscle should really not be an option any longer in plastic surgery (IMHO).

Hope that helps.

Thank you for your question.
If you're considering breast augmentation, talk to a plastic surgeon. Make sure you understand what surgery involves, including possible risks, complications and follow-up care.