Dual plane or submuscular for me? I can't decide if I want round textured or smooth (Photo)

Question

i am 158cm, 48kgs asian girl. i'd like to be a full C but not to big incase it sags. I'd like to fit better into my clothes. i attached some of breasts i like and 2 of myself now.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate
your question.

The best way
to determine implant size is based on chest wall measurements that fit your
body.  Once we determine that we can choose the profile based on what you
want or need to achieve.

Implants
under the muscle, there is less risk of capsular contracture.  Anatomic
implants tend to give a more natural shape with more nipple projection.

The best way
to assess and give true advice would be an in-person exam.  Please see a
board-certified plastic surgeon that specializes in aesthetic and restorative
breast surgery.

Best of luck!

Dr. Schwartz

Sheila S. Nazarian, MD · Answer

Choosing the right size, shape and placement of implants depends on any number of factors most of which require an in person exam. So, my best advice would be for you to schedule a consultation with a board certified plastic surgeon in your area (link below) to discuss your options. Best, Dr. Nazarian

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi.  Don't worry too much about the technique as your surgeon will guide you and due to your good anatomy you are likely to get a good result regardless.  Dual plane is just a type of submuscular and dual plane 1 or 2 would be fine for you.  Personally I think you have enough tissue to have a textured round implant in the subglandular plane.  I believe smooth round implants in the subglandular plane have a higher capsular contracture rate.  Regards

Charles Galanis, MD · Answer

Thank you for the thoughtful questions.  Dual plane and submuscular are typically very similar.  The question is typically more a decision between submuscular (under the muscle) and subglandular (over the muscle).  I prefer under the muscle due to better perceived capsular contracture rates and increased soft tissue coverage of the implant.  As far as textured versus smooth round, after they are placed they should essentially feel the same.  The principle reason to get a textured implant is in the hopes that it will decrease your rate of contracture.  I typically only use textured round implants for revision surgery and not primary augmentation.  Obviously this forum is meant to give you some general information.  There is no substitute for an in-person consultation and examination with an experienced plastic surgeon who can discuss this all in greater detail with you.  Good luck!

Naveen Setty, MD · Answer

Thanks for your questions and pictures.  Based on your pictures, it appears that you have reasonable expectations and should get a nice result with your surgery.  Submuscular and dual plane positioning of implants are typically very similar especially in a patients such as yourself.  Total submuscular placement of implants is very rarely done and I would highly suggest not going that route.  As for smooth versus textured, they both can give nice results.  There is some data suggesting lower capsular contracture rates with textured implants in a submuscular (dual plane) position.  I think you will get a nice result with either approach.

Vincent N. Zubowicz, MD · Answer

There are advantages and disadvantages when placing implants above or below the muscle. In my opinion there are few indications for textures patient is I don't feel it decreases capsular contracture.

G. Wesley Price, MD, FACS · Answer

The difference in a dual plane placement and submuscular is very subtle and in fact could vary among surgeons. Be sure your implants are placed under the muscle ( no matter what the technical variation is) instead on on top and you will be ok.. As to smooth vs textured? You can get a good result with both and some depends on the surgeons own experience. For a round implant I have always found that patients like to look and feel of the smooth style as they are mobile and not "stuck" in  one place. If you use a "teardrop" shaped implant then you should have a textured one so that it does not rotate.  Just be careful with going too big as you are a small person

Jourdan Gottlieb, MD · Answer

There are no fixed definitions for these terms. Almost all surgeons who are placing implants under the muscle are using a dual plane technique, in that the upper 50-70% of the implant is under the pectoralis major muscle, and the lower part of the implant is under breast tissue. If you look at an anatomy drawing (google search if you wish) you can readily see that if an implant were placed entirely under the pectoralis muscle, the implant would be way too high.  The lower edge of that muscle is about even with the lower part of the areola. There are proponent of smooth, and proponents of textured implants. When placed above the muscle, capsular contracture is less common with textured products. Under the muscle it is not clear if there is an advantage.  This is a question to be discussed with your surgeon.All the best.

Chad Robbins, MD · Answer

Thank you for your question and the photo's which are very helpful.  I believe you are a great candidate for breast implants and you know what you want for your final result.  I recommend you meet with a highly trained plastic surgeon in your area, ideally meet with several.  Bringing your photo's of your desired size is helpful, however, make sure you discuss not only cup size, but proportion .  Cup size varies depending on who makes the bra, as well as a woman's frame.  A  "c" cup for you may be a "b" cup for another.

Tom J. Pousti, MD · Answer

Thank you for the question. 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. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.  In my practice, I would likely recommend the use of smooth round silicone gel breast implants placed in the dual plane (most common positioning of sub muscular breast implants) position.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "full C cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

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