Submuscular breast augmentation on slightly saggy breasts? (Photo)

Dear Bktucker,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thanks for your question! I think as long as you are comfortable with your nipples always sitting a little lower on the breast mound, you will be fine. Good luck!

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Thank you for the question. We place the implants with the bottom of the implant at the natural crease. The implant won't drop into the breast tissue, it will settle into its pocket, but without a lift the breast tissue may "fall off" the implant and the nipple position, being lower than the middle of the breast, will still be low.

500 cc implants are large and weigh over 1 lb each. When placed in the submuscular position, they will extrude inferiorly and laterally and your breasts will bottom out and possibly give you a double bubble appearance. I recommend smaller implants with a circumareola approach. At that time, excess skin can be removed to lift the nipple-areola complexes higher and more medial and implants placed.

Best Wishes,

Gary Horndeski, M.D.

Implant volume, profile and positioning are all critical elements of a well performed breast augmentation. The implant must sit within the ideal footprint of your breast. Think of the footprint like the foundation of your home. If the nipple and breast tissue sit too far below the footprint, then the tissue will hang off the implant and look unnatural. I think that detail underlies your concern for whether or not your implants would drop enough to support your natural breast tissue. Based on your photo, I think a well selected implant would support your tissue correctly.

I would suggest going with something smaller. Long term, large implants are heavy and will stretch and thin your own tissue and will sag. I think 400 cc's would fit your frame much better.

Even in breast augmentation “less is More”…I am fascinated that somehow in US the tendency is to achieve “Baywatch” look at all costs…Number one reason that I see patients needing a re-do surgery in less than 10 years is that the initial implant was just too big “.”To the point- ask for a sizer and try it in a sports bra (lower profile bit flatter implant sample works best- ask for a shaped implant too), perhaps wear it for a whole day… don’t ask friends, don't even look at the CC’s, start small, just put on your t-shirt or other more fitting clothes and take it for a test drive… look at the mirror once or twice and stay off the internet, do not look at hundreds of “before and after” unless your twin sister is there …
Not likely that you would need a lift
More to the point:-I am pretty sure that anything half the size would be plenty…-I routinely review few examples with my patients at time of the consult and show them truly natural breast augmentation results and then casually ask them if they like the look and how big the implants are in their opinion… typical answer is at least 150 to 250+ cc off… so when patient had 200 cc implant they thought it was 400 etc-as implants get bigger they much quicker get wider and smooth round implants eventually will head in the path of least resistance- into the arm pit. So one of the size determination should be your breast width - in the straight on view- distance where breast starts in the cleavage area to the line that determines “edge of the arm pit” - if the implant fits great. If in doubt go size smaller “.”-do consider gummy bear Mentor shaped implants- they do best even in breast cancer reconstruction patients. They allow for softer look and nipple position can be bit lower and look great. Added bonus- they are less likely to migrate, less rippling of any implant and definitely less likely to create overly round top aka like Pamela Anderson…-its great to have a look where strangers don’t ask “who did your surgery?”… but are simply jealous of the appearance -its easier to buy clothes that fit without busting open and swim suits that don’t need separate tops and bottoms-even 200 cc with a specific bra can make one look as DDD - but being DDD all the time (during activities, kids care, business meetings, etc) is not fun.-remember that this surgery should provide results for 15 years or more providing steady weight etc-when we as surgeons do breast reduction surgeries, we routinely remove 3/4 or a pound or more breast tissue and patients get dramatic improvements in neck, shoulder pain- 500cc is more than 1 pound-I see patients weekly who come for another opinion being told that they could get 450 or bigger implants… we typically would do 200 or so and 1 year later, after things settled, I often get the message or a card with “thank you for not letting me go bigger and not making me look like a suburban housewife…”-even though it is an elective surgery that patient pays for - it is surgeon’s responsibility to educate and explain the choices that are reasonable and SAFE - and Yes- surgeons do need to say “NO” at times too- after all, Dr Google is not a plastics surgeon-I routinely see patients who ask for a specific size implant- I ask how did they arrive to this “number”- frequent answer: “my friend got xxx cc’s and I want to go bigger” - not a good strategy and this definitely will lead to trouble-implants is not an area to save money on- pick the best ones
Ask questions and second opinions are OKIf something sounds vague or “too good” … slow downAsk what local hospital the surgeon has privileges at - just in case - even if surgery is done in surgery centerGood luck!

An in person evaluation is needed for the best recommendation. From your photo it appears that 500cc implants will give you the fullness you are wanting. The position of the nipple will not change much but the breasts will have more volume. Keep in mind that the implants you are considering are on the heavy side so a lift may be needed in the future as the tissues stretch.

I suggest having multiple in person, consultations with plastic surgeons in your community who seem to have a lot of experience with breast augmentation surgery. At that point you can get a more accurate assessment and better understanding of the procedure. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own. And experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Take care notes during each consultation especially in regards to the quantity and quality of before and after pictures. Ask each provider what are most common Revision surgery is, what the revision rate is and what the revision policy is.
Being board-certified in plastic surgery does not mean someone has mastered anyone particular procedure. The biggest mistake. Most patients make is scheduling only one consultation. Schedule multiple consultations, then choose to provide her you feel most comfortable with.
Best,
Matt Hagstrom, MD