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

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.

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.