What will a 170 cc over the muscle, low profile gummy bear implant do for me? Will my breasts look natural and not stiff?

Question

I've always liked my breasts but after my 3 rd baby I have a hard time finding bras and I have nipple ptosis (couldn't catch it in pictures, very unflattering though). I also look flat in swimming suits. I am not comfortable with much more projection but I'd like more roundness. Under the muscle is not an option for me, I just won't do it. I would like to know if a small implant will make quite an improvement in my look and make it easy for me to find bras and look youthful as I age. Thank you.

Orna Fisher, MD · Answer

Thanks for your question! Very small low profile implants won’t do that much for you.  Particularly the low profile part.  Moderate projection would likely do very nicely given the look you are interested in and based on your photos. Small implants could be fine if you are petite in size and stature, but I can’t say for certain without  examining you in person. The “gummy“ part is fine as long as you choose the softest one it will not be stiff, unless you develop a capsular contracture. 
Although you state that you don’t want implants placed under the muscle, you should know why going over the muscle is not recommended. This will predispose you to the development of capsular contractures.  While there are certain factors that we don’t understand regarding why capsular  contractures happen and in whom, placement of the implant above the muscle is something that we do know and should control for whenever we can. That’s not to say that you would get one for sure, and if you did it might be very mild, but we have no way of knowing. As long as you understand the risks involved, you can plan as needed.

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.
Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Gerald Minniti, MD, FACS · Answer

Hello,Implant size is determined by in person biodimensional analysis and patient goal interpretation. Implant type is governed by a variety of factors, but its safe to say that gummy bear, or highly cohesive silicone gel implants are not for everyone. Your desire for a natural look is subjective, and requires careful determination by the surgeon. However, given a range of results from 'natural' to 'fake', there are a number of variables that can influence placement on that spectrum. In general, implants placed over the pectoralis muscle (even 'subfascial') will be more visible and leave an unnatural appearance, even when there is 'satisfactory' breast tissue coverage. Further, implants placed over the muscle tend to develop capsular contracture more readily than those placed in the subpectoral position. Whatever your issues are with that placement is unfounded, as it has the lowest complication profile, is not more painful when done correctly, is tolerated by athletes, and has a low risk of animation deformity.

Gary M. Horndeski, MD · Answer

Another alternative to consider rather than implantation is a breast lift with possible fat transfers.  There are 2 alternatives to consider.  One is a modified Benelli lift where a circumareola incision is made to reshape your breast tissue and elevate them higher on the chest wall.  The other is 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 and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are note lifetime devices.  Fat transfers are permanent and incorporated into the body.     Best Wishes,Gary Horndeski, M.D.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question and congratulations on returning to such great shape after your third child.  Most women pursuing a breast augmentation benefit from the projection:width ratio provided by moderate and full profile implants, instead of low profile.  Although any recommendations ultimately depend on your goals and an in-person examination of your tissues, I would recommend seeking out a series of ASPS board certified plastic surgeons with whom to consult and be sure to present with "inspiration" photographs to get the best advice.

Daniel Barrett, MD · Answer

Dear lunatica33,
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

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.  There seems to be is a moderate amount of breast asymmetry and the use of different sizes of breast implants may help to improve overall breast symmetry.Much of the final “look” and feel achieved with breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” and feel will be optimal.  
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue.  In other words, if a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
4. The size and model of breast implant used may make a significant And then you open a website run at 866difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C or D cup” etc. may mean different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
  
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. I hope this helps. Best wishes.

Curtis Wong, MD · Answer

because you are obligated to accept all the risks that come with them and smaller implants to me are simply not worth it and would suggest you consider every other way to  provide fullness to where you want it using fat grafting (assuming you have some that could be harvested and used).  Its natural, it will improve your contours elsewhere, and it is permanent without the downsides of implants.  That seems like a win win to everyone.

Johnson C. Lee, MD · Answer

The ideal Implant size cannot be determined by height and weight alone. It is best to have an in-office evaluation so that careful measurements can be taken to determine the best size implant for your chest diameter, several upper body measurements, and current breast tissue. Once you have the measurements, they are all put together to determine the right implant from the right manufacturer. Breast implants of the same cc's can look and feel extremely different depending on the profile and material. In my office, I have the MENTOR breast implant sizing system where different size molds are used to simulate how you appear in your own clothes and help finalize your decision. 170cc gummy implants are definitely smaller so they will allow your breasts to appear more natural and remain soft even if you place them above the muscle. The ability to place the implants above the muscle will depend on your existing breast tissue thickness and other measurements. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
Determining the “perfect” breast size before a planned breast augmentation is quite a difficult task. Each individual has a different concept of “normal” breast size. In addition, there is no standardization of bra size in the manufacturing  industry. One company’s “C” is another company’s “D”.
  
There are various ways to determine desired breast size. Bringing in “wish pix” to demonstrate to your surgeon will make him / her aware of your anticipated goals.  Placing an implant in a bra gives an extremely rough idea of anticipated breast size. One may estimate volume by adding rice to a baggie ( 1 cc  1 ml) and adding the volume to your breast beneath a bra. Some surgeons offer computer imaging. 
  
The most important measurement is the base width of the implant. If you drop a vertical line from the medial most and lateral most aspects of the breast, and measure the distance between them, this suggests a base width. If an implant is too narrow, you will not have adequate cleavage. If wider than the base width, you will have excessive cleavage and “lateral boob”.  The fill of the implant then determines the amount of forward projection. I recommend you visit an implant website (e.g. Mentor , Allergan, etc.) as they will list base widths, fill options, and projections for each implant size they offer. 
  
I recommend a thorough discussion with your plastic surgeon to ensure that you are both on the same page. 
Best wishes…

What will a 170 cc over the muscle, low profile gummy bear implant do for me? Will my breasts look natural and not stiff?

Answers (11)

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