Is There Anything a Doctor Can Do to Create Under-boob That is Not Present in a Pre-op Breast? (photo)

The answer to your question is YES.  We are fortunate in 2013 to have a wide variety of implant choices (Shape, size, and fill material) to accommodate the desires and goals of every patient.  Choose a surgeon that specializes in breast surgery and is familiar with the various implant types, as well as, the various surgical options.  Ask to try on implants, ask to see pictures of the surgeons work, ask how many augmentation procedures he does a year, check his credentials and board certification.  There is much more information on our website.  Hope this helps.  Good Luck!

        Very few women have round breasts with the areola at the center of each breast.  Breast augmentation skillfully done can improve lower pole fullness without creating a double bubble.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

If there is no capsular contracture which restricts volume distribution of the breast the direction of gravity will determine where most of the implant volume will be distributed. Standing up will pull the volume downward leaving most of the volume below the horizontal pole of the breast.

In my opinion, the best option for you would be to go with silicone implants above the muscle.  Implants below the muscle will give you more upper pole fullness that you seem not to like.

A common
error that leads to an unnatural appearance after breast augmentation, even
with implants of an ideal size, is inadequate lower pole dissection and/or
inadequate release of the pectoralis major origin just above the inframammary
fold. As a result the implants sit too high and appear excessively full in the
upper poles (the area above the nipple-areola complex), while the lower poles -
which should be the fullest area of the breast - are underfilled. Inadequate
muscle release may also result in bizarre-appearing breast implant animation
when the pec major muscle contracts. In some cases this may result in one or
both of their implants jumping up literally to the level of a patient's
collarbones - an alarmingly unnatural look, and one that is totally avoidable 

Not sure over the internet is the forum to discuss these issues. Best to seek IN PERSON evaluations from a boarded PSs in your city. 

Thank you for the question and pictures.

Yes, plastic surgeons can often “create” more lower pole fullness ( what you referred to as “under boob”)  while dissecting the breast implant pockets.  Ultimately, careful selection of plastic surgeon and careful communication of your goals will be key. There is no specific type spot size/profile/incision line that helps achieve this lower pole fullness/volume.

I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” 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 do not think that you will experience a loss of strength or flexibility after breast augmentation,  regardless of the location of breast implant placement.

However, as you may know, sub muscular (dual plane) breast implant positioning does have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle).
 Again, I think the advantages of sub muscular (dual plane) breast implant placement far outweigh the  potential disadvantages associated with breast implants  placements of glandular 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're 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. I have found that the use of words such as “natural”  or “C or D 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.






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.





I hope this (and the attached link) helps.