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   

Based on your photos but without an examination, you can achieve an excellent cosmetic result with an augmentation. There are two choices for breast
implant placement: sub-glandular (under the breast tissue and in front of the
chest muscle – the pectoralis muscle) or sub-muscular (under or partially under
the chest muscle). The best location depends on many factors including: tissue
thickness, weight, desired outcome, and individual anatomy. Each position has
advantages and disadvantages:

Subglandular implant benefits:A shorter recovery time.
Less discomfort initially.
No distortion of the breast when the pectoralis muscle
flexes.
Mild preoperative sagging can be improved, especially
if no breast lifting procedure is performed.
Easier surgical procedure.
Larger implants can be placed.


Subglandular
implant disadvantages:The implant may be more visible.
More visible rippling, especially in patients with a
small amount of natural breast tissue.
Generally, saline implants do not produce a good result
in front of the muscle.
Higher incidence of capsular contraction.
“Bottoming out” in some patients.
Some radiologists have more problems reading a
mammogram with an implant in front of the muscle.


Submuscular implant benefits:Usually results in a better appearance for naturally
small breasted women
Less tendency for seeing ripples of the implant.
A more natural feel to the breast especially in slender
women who don’t have much of their own breast tissue.
Less interference with mammograms, although most
radiologists take additional views no matter where the implants are
placed.
Lower rate of capsular contraction.
Less of a chance of “bottoming out” where the implant
bulges at the lower aspect of the breast and the nipple and areolas tend
to appear excessively elevated.


Submuscular implant disadvantages:Recovery usually takes a little longer and is more
uncomfortable initially.
There may be an “animation deformity”, which is a
temporary distortion of the breasts when the pectoralis muscle is flexed.
Body builders and weight lifters generally prefer implants in front of the
muscle.
It is harder to achieve cleavage in women who have
widely spaced breasts.
The implants often ride higher on the chest.


Actually, most patients who have
breast augmentations today have breast implants placed in a combination or
“dual plane” position. This approach has the same benefits and disadvantages of
a total “submuscular implant”, but with a lesser tendency to ride high on the
chest wall. The disadvantage as compared to a total “submuscular implant” is a
higher tendency for bottoming out.

The ideal placement in any
particular patient depends on their particular anatomy and understanding of the
pros and cons of each approach.

Keep in mind, that following the advice
from a surgeon on this or any other website who proposes to tell you what to do
based on two dimensional photos without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of each operative procedure may not be in your
best interest. I would suggest you find a plastic surgeon certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with or if you plan to have the surgery in Australia, the surgeon should
ideally be a member of the International Society of Aesthetic Plastic Surgery
(ISAPS).
You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

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!