Can a Small Implant Placed Above the Muscle Look Natural in a Thin Woman? (photo)

Question

I am having doubts between submuscular and subfascial placement. I am a thin woman, which for most PS is a sign to go with submuscular or dual plane augmentation. I want them to look good but I am afraid of distortion of the breast with muscle contraction, rippling and implant edges being very visible. Can a small implant 200cc - 250cc placed in the subfascial plane look natural in a thin woman? Or is it better to consider a 280cc placed submuscular? I am 5.1ft, 88lbs and BWD of 11cm. Thanks

J. Jason Wendel, MD, FACS · Answer

Yes, a small implant 200cc - 250cc placed in the subfascial plane can look natural in a thin woman. A 280 cc implant is only 12% larger than a 250cc implant. If distortion on muscular contraction is a big issue for you, go subglandular/subfascial. Be advised, however, that submusclar can be easier for mammograms and has a lower rate of capsular contracture.

Rian A. Maercks, MD · Answer

Your concerns are well warranted and there is a lot of conflicting information out there!  My first piece of advice is forget about subglandular, even if it looks great immediately it simply will not last long.  When it comes to dual-plane adding coverage, well this depends on your definition of coverage.  The pectoralis major ALWAYS has tone in it, therefore if used to define the superiorpole, it will ALWAYS INCREASE definition of the implant and create a sooped out unnatural look.  

	 

	The advantage of true subfascial augmentation is that supporting tissue can be draped over the superior pole of the implant creating a natural tear-drop effect even with a round implant.  I prefer what I call the 'cold-subfascial breast augmentation' because it protects all of the fascia to accomplish these goals.  Beware, there are many surgeons that advertise their 'subfascial' technique but completely destroy the fascia thus delivering a subglandular result.   Pay attention to before and after pictures and these will become obvious to you.  I hope this helps!

	 

	 

	All the best,

	 

	Rian A. Maercks M.D.

Joe Gryskiewicz, MD, FACS · Answer

I favor putting implants under the chest muscle because my radiology colleagues think this position interferes less with mammography and the early detection of breast cancer than if the implant is placed on top of the muscle. Not all surgeons agree on this, but I like to err on the side of caution. The alternative is to place the implant on top of the muscle but under the breast tissue. The chance of irregularities is much higher when the implant is placed on top of the muscle in a patient who has little overlying breast tissue to cover the edges of a saline implant (incidentally, this isn’t as big a problem with silicone. All the best.! "Dr. Joe"

Michael M. Omidi, MD, FACS · Answer

Yes it is feasible to achieve natural looking results but it is hard to say for sure based on photos alone.   As I stress with my patients, the choice of implant
size and type would best be done through an in-person examination.  There
are a lot of factors that can affect your choice like the desired end result,
breast tissue, body measurements, and the like. It would
always be best to visit your board-certified plastic surgeon and get a full
evaluation for your concerns.  Best of luck, Dr. Michael Omidi.

An
in-person exam with a board-certified plastic surgeon is the best way to assess
your needs and provide true medical advice.

Ralph R. Garramone, MD · Answer

The over the muscle, under the muscle question has no simple answer.  Either position will result in a natural appearance if the procedure is performed well and an appropriate sized breast implant is selected. These two aspects of the procedure are most important.  Different plastic surgeons feel strongly one way or the other, sometimes for no reason other than they do it more often one way or the other. One option may work better for a certain type of patient and this is related to breast volume, breast shape, droopiness if present and the amount of body fat.


	 

	
		The simple reason to have the implants under the muscle is to add an extra layer of coverage over the implant to avoid wrinkling or edge visibility.  The down side is the possibility of implant movement with muscle contraction.  Having said that, in my experience, wrinkling and implant visibility is much more common than implant movement, which the patient finds to be a problem.  I have not actually had a patient complain of implant movement after a breast augmentation and most of the breast augmentations I perform are submuscular. In a body builder the movement may be a problem, but in the average patient this is usually not an issue.


	 

	
		By your photos you actually seem to have a moderate amount of breast tissue and it will be up to you and your plastic surgeon to decide which way you will like to go given the advantages and disadvantages of each procedure.  I think you are wise to be considering conservative sized implants, as these tend to look more natural in most patients.  In my opinion, the subfascial plane is essentially going to have the same appearance as subglandular since that layer is essentially paper thin and does not add any additional coverage compared to the extra coverage that the muscle affords.


	 

	
		In most cases when the breast implant is submuscular it is only partially covered by the muscle and the term dual-plane refers to the fact that the superior part of the implant is covered by muscle and the lower part of the implant is not.  The plastic surgeon can vary the position during the breast augmentation procedure in order to adjust the appearance of the breast.  This can particularly helpful in the breast with some droopiness.

Steven Wallach, MD · Answer

I think you answered yoru questions yourself.  FIrst please note your aysmmetry( everyone has it). But with thin patients it is often better to place them in a dual plane position.

Aaron Stone, MD · Answer

Your posted photo shows widely spaced breasts without cleavage, stretched out areolae,right breast crease higher than the left, right nipple higher and further from the midline than the left nipple and right breast smaller than left. Every approach has its pros and cons you will need to weigh those before deciding what to do. Under the muscle implants can distort with muscle movement if the muscle release is inadequate but the risk of visible rippling is less.
	
	In your case it is as or more important to make surgical adjustments to the breast skin and tissue and place a larger implant on the right side. The right breast fold will likely need to be lowered and the nipple complex positions adjusted in order to achieve an optimal result. You do not have cleavage now and it is important to realize that breast implants cannot create that cleavage.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Tom J. Pousti, MD · Answer

Thank you for the question.

	I would suggest sub muscular ( dual plane) breast augmentation in your case.

	Although breast implants in the sub muscular ( or dual plane)  position may experience &ldquo;distortion&rdquo; with muscle movement (workout) I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the &ldquo;dual plane&rdquo; sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

	The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

	I hope this helps.

John P. Stratis, MD · Answer

First, we need to clarify the facts. Implants above the muscle have a higher chance of visibility and rippling than those below the muscle. Ultimately, the visibility will be related to the size of the implant vs the amount of breast tissue present. You appear to have sufficient amount of breast tissue to hide a smaller implant. 

	You should also be aware that although there can be distortion of the implant when they are placed under the muscle you will probably be the only one who will notice this.

Peter E. Johnson, MD · Answer

Muscle distortion can be a problem, and also a smaller implant can pose a challenge under the muscle if it will not fill out the breast envelope well. Subglandular augmentation can work out very well and it appears you have enough coverage for an excellent result. You do have some asymmetry which will be only partly be corrected with the implant.

	Best of luck, peterejohnsonmd.com

Can a Small Implant Placed Above the Muscle Look Natural in a Thin Woman? (photo)

Answers (15)

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