Advice for breast augmentation
The first step is to decide what breast size you want to achieve with breast augmentation. Regardless of volume if you choose saline it would be better to undergo under the muscle, and if you choose over the muscle you should go with silicone. In the ideal world any breast ptosis would be addressed with some type of breast lift as a breast augmentation is primarily designed to improve volume. If the amount of ptosis is very mild then a silicone implant of a certain size and diameter on top of the muscle may help. Based on your photos you may be able to go with a small implant on top of the muscle +/- a purse string mastopexy if needed.
All the best,
Implants being placed over the muscle to "lift" the breast is not an effective way to treat sagging breasts. If you need to have your breasts lifted, then you need to have a lift. Lift come in variable shapes and sizes, but all come with a scar. The issue is not just adding a bigger implant which will eventually lead to more significant droop. The key is getting the best operation. and not setting yourself up for failure with a second procedure, more costs and more time out of your schedule.
Consult with several surgeons to get the MOST accurate information, and trust your judgement on whether their information sounds accurate and beleivebale. Going under the muscle may lead to an animation deformity - the implant can move with the pec muscle, but this is usually less of an issue with visible implant edges or rippling.
Best of luck
Vincent Marin, MD
San Diego Plastic Surgeon
Professional, competitive body builders and fitness models are usually better off with implants placed above the chest muscle. I suggest listening to your surgeon, or seeking a second opinion based on a physical examination and discussion of your goals.
The choice is yours but there is +'s and -'s for each location.. There may be flexion deformities under the muscle however, if you do not have a lot of soft tissue coverage, it gives more coverage int he superior pole. Under the gland may limit the coverage. As for strength, there probably is no effect on weight lifting ability once you have healed.
Submuscular implants are usually better than subglandular.
Subglandular implants have several potential disadvantages compared to submuscular:
possible higher capsular contracture rate over the muscle;
more risk of visible rippling;
more visible implant borders;
lower implant position/less upper pole fullness;
perhaps less longevity of the result due to less soft tissue support.
Some surgeons do prefer to place the implant over the muscle when there is mild to moderate droop, but for the above reasons, I think the disadvantages outweigh the benefits.
In some cases a breast lift (mastopexy) is needed to elevate the breast tissue and center it over the implant. In some cases a dual-plane augmentation, in which the pectoralis muscle is released from the breast tissue, to allow the implant to settle a little lower, may also be a viable option in some cases. The optimal choice depends on the degree of droop, anticipated size of the implants, skin and breast tissue quality, etc.
Thanks for your question.
Breast Augmentation and Droopy Breasts
When deciding on the position of the implant either under or over the muscle it is very important to consider how much 'sag' your breasts have and whether or not you are going to do a lift. I usually place my implants under the muscle, however, in a patient who has mild breast 'sag' but does NOT want a breast lift as well, I place the implant over the muscle as your surgeon has recommended for you. This helps to prevent a 'Snoopy Dog' defromity in which the breast itself droops over the implants which are positioned higher on the chest when placed in the subpectoral position. A board-certified plastic surgeon will guide you appropriately and, based on what you describe, it appears you are heading in the right direction. Best of luck!
Over the muscle vs under the muscle implants
I generally never recommend placing implants over the muscle for any reason. Implant placement over the muscle has more cons than pros in my opinion. Sub muscular placement is superior for many reasons: Less contractures, more than just skin envelope to hold implant in place, etc. If you are in need of a lift and would like larger breasts, then I would recommend a breast augmentation with a donut mastopexy (scar around the areola). If you just want a lift and no implant, then I would suggest an Ultimate Breast Lift. This technique to lift your breast mound without any visible scars. It reconstructs your existing breast mound to form an inner cone to give you projection and cleavage. Hope this information helps you. FYI, implants will always stretch tissue with time; requiring you to need lifts periodically. Hope this info. helps.
Droopy breasts and implants
It is important to understand that implants alone can not achieve a significant lifting of the breast. Your surgeon should guide you to perform the right operation for your breast.
I understand the photos in this question are not yours. The result is an acceptable one for some individuals who are willing to sacrifice breast aesthetics to avoid scarring. The areola remains quite large and the nipple position is too low. This has nothing to do with implant position above or below the muscle.
There are advantages and disadvantages to both positions. There are also ideal breast types for the subglandular and subpectoral position.
Seek out a board certified plastic surgeon to explain these issues to you so you can make the correct decision for you.
Good luck and I hope this was helpful.
Over the muscle will probably give you a more natural appearance
Since you do have some drooping of your breasts, if you do not wish to have a breast lift done, then I would recommend breast implants on top of the muscle for a more natural look. For the best results, I would recommend a vertical ellipse mastopexy and submuscular implants.
Droopy breast, over or under the muscle
There are advantages to submuscular augmentation, however the implant must fit within the skin envelop of the breast, hand in glove, to look and feel 'right'. If you wish only a small increase in volume, say 270cc, and the skin envelop is fuller, the implant may sit better and blend and flow better in a subglandular pocket. The implant under the muscle, if not large enough to 'flesh out' the breast may allow the breast itself to move over the implant in a kind of disconnect. Your doctor is probably right.
Best of luck,