Do You Lose 50 Cc's with Behind the Muscle Silicone Implant Placement?

Silicone implants placed behind the muscle will generally look about 10-15% smaller than the implant that you may have tried on in your surgeons office.  The implants that you try on are outside your body and therefore appear larger.  Once the implant is place under the muscle during surgery, it is also under your own breast tissue and your chest muscle.  The muscle is tight and pushes the implant back resulting in less projection of the implant.  That is why the implant looks smaller once it is inside your body under the muscle.  If you try on a 300cc implant in the office and like the size, then you should choose a 325-350cc implant for your surgery.  Once the 325-350cc implant is placed under the muscle, it will look like the 300cc implant that you tried on in the office.

This is a great question as sizing is the most difficult part of a breast augmentation for women.  The implant can be placed above or below the muscle depending on the individual needs of each patient.  In the United States the most common method is under the muscle, however both methods are great if used in the correct situation. 

Placing the breast implant below the muscle helps decrease the risk of capsular contracture (abnormal scar tissue around the breast). It also helps women have a more natural and soft appearance to the breast as the muscle acts as an insulation layer between the skin and breast implant.  This will decrease the chance that their will be visible rippling of the breast implant as well. 



Placing the implant below the muscle does typically make the implant look slightly smaller as the muscle will give the implant a touch more of a natural slope.  It also compresses the implant, which makes the breast look slightly smaller.  When sizing I typically encourage my patients to go up one implant size, which is 30 to 50cc to make up for this difference.



I would encourage you to spend some time sizing and discussing your implant choices with your plastics surgeon.  Your board certified plastic surgeon can help guide you in finding an implant that will help you achieve your aesthetic goals.  

It can be said that you lose some appearance of volume when the implants are placed behind the muscle.  We take this into account during the sizing process.  The implants you have chosen should give you the look you are trying to achieve.

Implant sizing is part science, part art. It isn't possible to predict exactly what you'll look like after surgery, even with detailed measurements, since there are many variables that affect the results. The main difference that you may notice when placing a silicone implant behind the muscle is that the implant may have less projection than when the implant is over the muscle. This means that the implant is flatter, sticking out less from the chest. Using an implant slightly larger than the sizer you tried is reasonable, but the best option is for your surgeon to insert a sizer implant at the time of surgery to see how it looks in YOUR body. I always take a few implant sizes to the operating room, and confirm the appropriate size using a sizer implant. If your surgeon inserts a 350 cc sizer and it looks like the result you were seeking, and fits your tissues well, then that would be the size to use. If the sizer seems like it will distort your tissues excessively, then a 300 cc implant may be better to use. It takes a few more minutes in surgery to check with a sizer and sit the patient up, but the results are undeniable. The most common reason for reoperation after breast augmentation in the first three years is size change. In 16 years, I have performed only a HANDFUL of revisions for size change. 

The size of the silicone implant can appear smaller when placed under the muscle and breast tissue.  It is important to discuss with your plastic surgeon the size and shape desired with your breast augmentation.

The shape of the upper pole breast, cleavage midline, lateral fullness and projection help determine the type of silicone implant to be chosen during the surgery.

Recently, the Vectra 3D virtual breast augmentation pictures have significantly helped predict patient results, using saline or silicone, above and below the muscle. If there is a plastic surgeon with 3D imaging in your area, this may help answer your current concerns regarding the breast augmentation.

Good communication between the patient and plastic surgeon

 

is the key to choosing the best size implant for each individual. The surgeon should be willing to work on this for while during the consultation. I allow patients to return for a second shorter consult at no charge if they are concerned about their choice of size.

Steps:

1. I look at how large the patient is now, how large she was during pregnancy and breast feeding if applicable, whether she has lost volume and what her goal is for her final cup size.

2. I look at the patients height, frame, weight, waist, shoulders, and chest measurements. This helps me understand what range of implants will fit well on this patient and look proportional to her body. Most women want to be larger but proportional.

3. The patient then tries on gel filled implants in a bra and puts on a relatively tight T-shirt to judge how they would look with each size in their range. The also try on high and moderate profile implants. This is a step by step process which takes some time. I ask the patient to say if she feels each size is too big, too small or about right, until we find the one size she likes the best.

Quite often the implant that fits the best by their measurements is the size they naturally like the best. I find women usually know what size looks good on their body and their opinion should be the most important factor in the final decision.

Key points:

1. The final result often looks slightly smaller so often I tell the patient I plan to add 25 or 30 ml to what they have chosen if they consent to this.

2. Many women make the comment, "I wish I had gone a little bigger" at the 6 month postoperative visit, so I usually suggest if its down to two possible choices, take the larger of the two. This is partially unavoidable because it is human nature to get used to your new size and wonder what if... I have had fewer problems with this by suggesting that women chose the largest of the sizes that they liked when trying the implants on.

 

 


 



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Submuscular placement which is most common will compress your implant more and so the same volume implant will appear somewhat smaller in this space compared to on top of the muscle.    

Great question  - and it certainly is relevant in my practice since I have women try on implants within a bra.  I use the number 25 cc as a rough estimate as to how many cc's you lose in appearance between an implant on top of the skin versus under the muscle.  Best of luck!

There is no exact science to how many cc's you will "lose" once the implant is behind the muscle.  Typically, I advise my patients that if they like the look of the implants we try on, we should consider one size larger to get the look of the smaller implant.  The good news is that if you aren't completely satisfied with the 350cc implants, doing an implant exchange is a relatively simple surgery.  Good luck!

In general, it seems that external silicone implant sizers are the best way to for my patients to get an idea of what an augmentation with achieve for them.  That said, they do seem to appear somewhat larger in a bra than when they are placed in the patient; even more so the deeper they are placed (i.e., sub muscular may seem smaller vs sub glandular.  This is probably due to implant definition being less with deeper placement.  For this reason, if patents are trying to decide between two sizes, I generally encourage them to choose the larger of the two sizes as implants may appear smaller than sizers.

The short answer is yes, you tend to lose a little bit of "volume" when the silicone gel implant is placed sub-pectoral or behind the chest muscle.  In order to accommodate for the patient's aesthetic objective for their breast augmentation procedure, surgeons will typically increase the implant fill by choosing an implant roughly 50cc larger to accommodate for this compression of the implant by the chest muscle.  In my practice, I employ both physical breast sizing, using implant sizers, and 3D Vectra imaging to best help my patients elucidate their surgical goals.  A comprehensive conversation with your operating surgeon should help define what type of implant in both profile (dimension) and size your surgeon will use and this should really help to put the patient better at ease.  I always remind my patients that implant volume does not necessarily correlate to cup size, as cup size is variable between bra manufacturers and relies on other body measurements.  Be frank with your operating surgeon and discuss your concerns.  Good luck!