Breast Augmentation. Would above the muscle be an option for me?

Dear Tb,   Thanks for submitting your pictures.  From observing your pictures , you appear to have nice and perky breasts with wide cleavage and your size looks like small A cup.  I have been in practice for 29 years and performed breasts augmentation with implants on many athletes. The most common size selected by these patients was full B cup size or small C cup size, which makes sense due to their intense sport activity.   In regard to implants size selection, you did not provide your chest circumference in inches, which is critical for the correct implants size selection. Let's assume that you are currently  34 small A cup size. To become 34 small C cup size, you will need implants with volume of 300 cc.  I place the implants through a sub areola incision as oppose to sub mammary fold , because the scar is friendlier  and this entry allows for pocket dissection under direct vision and feel, which creates beautiful cleavage, symmetrical breasts and precise fold.   As far as pocket location, there is a reason why most surgeons in the US place the implants under the pectoral muscles.    Here are the reasons:  1. Much less loss of nipple sensation, because the nerves are crossing above the muscle, exactly where the pocket is made with the above the muscle technique.  2. Better coverage of the implants, especially importants in thin peoples like yourself.  3. Statistically, less capsule contracture.  4. Less hematomas, because the pocket under the muscle is almost bloodless, unlike the other technique.  Finally, one bird does not bring the spring and your one friend's nice outcome is insufficient to make a judgement. You have to do a good due diligence and choose wisely.   Always, consult with experience board certified plastic surgeons who do lots of breasts augmentation surgery in accredited surgery center for your safety. Most importantly, check the before and after picture in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky , symmetrical and natural looking. Also, check the 'Realself' reviews for rating and positive experience reports.              Best of luck,                                    Dr Widder   

I feel that below the muscle would be the best option and most of my patients have your body type and do very well with this. The most important thing is for you to have a nice shape, because the breast is already 'pretty' and you should preserve that, only with a fuller size. The upper 'slope' of the breast should look so natural that you can still wear sun dresses and halter tops and have the breast augmentation be your secret. I hope this helps.

Thank you for your question and the photos.  Although breast implants can successfully be placed behind the pectoralis major muscle (sub-pectoral augmentation) or in front of the muscle (pre-pectoral or sub-mammary augmentation) there are advantages and disadvantages to both methods.  In someone who is thin, such as yourself, you would most likely achieve a more natural result if the implants were placed under the muscle. You do not mention your friend's anatomy, but if she has a natural result with a sub-mammary augmentation, I would suspect that she is larger than you are. Typically a woman with larger breasts and some sagging might opt for over sub-mammary augmentation if they did not desire a breast lift and had adequate breast tissue to cover the implant. For someone thin and athletic, an implant in front of the muscle will result in a  higher, rounder, less natural appearance. In addition, depending on the implant size and shape, there can be more rippling and the implant will be more visible since there is often not adequate breast tissue to cover the implant.  With a sub-pectoral augmentation, there is much more natural appearance as the pectoralis major muscle provides additional coverage of the implant and they tend to provide more natural draping.  Mammography tends to be easier for those with sub-pectoral implants, and there is less incidence of capsular contracture.  Please talk to a board certified plastic surgeon who is familiar with both approaches to find out the best option for you.  If you were my patient, I would recommend a sub-pectoral augmentation for the most natural result.

IF the surgery is done well this is a fine option. You do have and increased risk of capsular contraction and long term results not great if you pick too big an implant which would stretch out your skin. Good Luck!

Most plastic surgeons recommend an "under the muscle"placement for two primary reasons: 1. The likelihood of capsular contracture (hardening or distortion) is less, and 2. The muscle tends to disguise the round counter of the implant in thin patients making it look more natural and less round a artificial. There is no doubt that above the muscle is a great operation when it works out. You are taking a bit more of a risk with the "above the muscle" option of needing revision surgery if the final result is not what you had hoped for. Plastic surgery is not risk free, regardless of the implant you select, the pocket placement, or the plastic surgeon you select to perform your surgery. An experienced board certified plastic surgeon will review all of your options with you. Make sure that you are consulting with a plastic surgeon whose aesthetics align with yours. And make sure that you communicate your visual endpoint with photos, not just with words like "natural", proportionate", "not too big", because all of these descriptions are notoriously subjective and inexact. Also, if you are not confident after your first consultation, don;t hesitate to schedule a second or even third. It is much easier and less expensive to do your due diligence ahead of time than to be disappointed with your outcome and undergo revision surgery.  Best of luck to you. 

From what I can tell, you are likely a good candidate for over the muscle silicone breast augmentation.  If you go under the muscle, your breasts will look like 2 puppies fighting under your shirt when you work out your chest.  To me, that doesn't look very natural despite what other doctors below have said.  You can choose from round or "anatomic" shaped implants depending on how soft you like the upper part of the breasts.  Also, if you go under the muscle and exercise you pectoral muscles, over time, the muscles will stretch out the internal breast implant pocket and cause the implants to drift laterally and downward.  If you would like more information, feel free to contact me.  Best wishes!

You are a great candidate for behind the muscle. It is ideal to have a much natural tissue in front of the implant in small breasted women to reduce palpability/rippling. Choosing the proper dimensions of implant will allow control of how much upper pole fullness you gain.

Breast Augmentation above the muscle has largely fallen out of favor by plastic surgeons.   There are many reasons why implants placed under the muscle is better.  1. Implants above the muscle add more weight to your breast which is supported only by your skin and will add to the tendency to droop. 2. Capsular Contracture (Breast Implant hardening) rates are much higher above the muscle than under the muscle. 3.  Most importantly, Cancer detection on mammograms is better with the implant under the muscle.  4. There are many other reasons why under the muscle is better.... less palpability of the implant, less visibility of folds and ripples, better superior pole fullness, lower risk of synmastia (uniBoob) You can never choose your surgery by someone else's results.  All breasts are different! DiscoverTheBeauty.com

Hello and thanks for the question. Comparisons with your friend are not reliable. She may have a great result because she had more native breast tissue to start with and small implants were placed. Please see a BCPS for breast and chest measurements. Good luckDrBurnett#realself100

It is possible to go above the muscle. My preference is to go below the muscle to give more soft tissue coverage over the upper pole.