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.

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!

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.  

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.

For reference - 50 cc's is less than 2 shot glasses in volume.It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in a bit.

The short answer is that yes, you need to chose a larger silicone gel implant than the one that you liked inside a bra.  This is especially true given that the implant will be placed below the muscle. Usually a 25-50 cc increase in size is about right.  However, many factors go into determining if you will achieve the result that you want (a "C" cup).  Cup size varies depending on the manufacturer.  In addition, your dimensions must be taken into account as well as the amount of skin stretch that you have. 

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.

Hello! Thank you for your question. In
general, implant size does not
correlate with bra cup size. The cup size itself will vary from
manufacturer to manufacturer as well as who is doing the actual
measurements. Thus, cup size is never a reliable indicator for your
breast size. I typically encourage my patients not to communicate her
desires in cup size but more on the actual look and appearance. Given
your desires, a breast augmentation, with an implant or fat grafting,
would be an ideal procedure that would meet your expectations. Breast
augmentation is now the most popular procedure performed in plastic
surgery today. One tolerated very well by women with minimal downtime
and high patient satisfaction.  There should be negligible difference with pre vs subpectoral placement and virtually unnoticeable.Good
communication between you and your surgeon of your expectations is
warranted - choosing your surgeon wisely is the first step. Discussion

of your wishes and having an honest and open dialog of your procedure is
mandatory (e.g, implant type, incision, placement, etc). I have found

that photographs brought by the patient is helpful to get a
visualization of the appearance you wish for in terms of size, shape,
fullness, etc. In addition, your surgeon's pre and postoperative
photographs should demonstrate a realistic goal for you of results.
Sizers are helpful during an in-office consultation. Once this has
been accomplished, allow your surgeon to utilize his/her best medical
judgment during the procedure to finesse the best possible result for
you after preoperative biodimensional planning and fitting the right
implant for your breast width. This is the most important determinant
for the sizing of implants, which will provide the optimal result and
most aesthetically-pleasing result for you.Consult with a
board-certified plastic surgeon well-versed in breast procedures who
will examine and discuss with you the various options and factors to
consider and help you decide which one will be the right one for you.
Hope me that this helps! Best wishes for a wonderful result!