I am getting 800cc round silicone implants. Can they be placed under the muscle? 5'4", 125lbs

Question

I currently have 500 (overfilled) saline implants and they are placed under the muscle, which created a very natural look and a very smooth transition from my chest top to the implant. I was choosing between the anatomic-shape implant and round but my PS said that the largest anatomic will not fit me (it is too wide for my rib cage) and I should go with the round 800cc ones, since it is the volume/cup increase that I want. Would placing it under the muscle give me the smoother transition on top?

Robert Cohen, MD · Answer

Silicone implants generally look and feel more natural than saline, and being sub-muscular (dual plane) is a better option than being over the muscle.  As other surgeons have suggested, you should probably think very carefully before increasing to 800cc implants.  Those implants will be very heavy and will place a significant load on the soft tissues, which will then stretch out over time.  You have a layer of scar tissue that has formed around your current implants that provides some extra strength.  I would recommend that you stay with an implant size that will fit easily within your pre-existing pockets to reduce your risk of complications.  Good luck!

Steven Goldman, MD · Answer

Larger implants have a much higher revision rate. 800 cc implants are basically considered temporary. It is very difficult for the breast tissue and skin to support the weight. Such implants are generally removed in a short period of time, followed by downsizing and mastopexy (breast lift). I would recommend textured silicone subpectoral implants in general if large implants are used. Over the muscle placement will not give enough support of big implants long term. Good inframamary fold support is also essential. Other maneuvers, like raising the breast pockets internally (with a capsulorraphy) to get better upper pole fullness from a smaller implant -- to create the appearance of a larger implant -- may be a better long term solution.  Do your homework. Make an informed decision. Risks like a high revision rate or subsequent mastopexy may still be appropriate for your overall goals. Get second opinions if needed. Good luck.

Mathew A. Plant, MD, FRCSC · Answer

If you already have a pocket under the muscle that can accommodate an overfilled 500cc implant then you should be able to get the 800cc implant under there as well. The choice of pocket placement is something you'll need to discuss with your surgeon who has examined you in person. Without examining you or seeing photos its difficult to give specific advice as to whether under the muscle or over will give the look you want. I'd suggest booking an appointment with your surgeon to discuss your concerns before you go ahead with the surgery. Best of luck!

Tom J. Pousti, MD · Answer

Yes,  assuming your anatomic dimensions allow, the 800 cc breast implants can be kept "under the muscle" during the revisionary breast surgery. Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery 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 are 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 "up a cup size” or "D or DD cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on 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 chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this helps. Best wishes.

Justin B. Maxhimer, MD, FACS · Answer

While placing implants under the muscle can help give a less "stuck on" look to your upper pole, I would think long and hard about going so big.  800cc implants on your 5'4" 125 lbs frame are very big and could give you lower back pain and a stretched out look over time.

Steven Wallach, MD · Answer

The implants you chose are very large. I do not recommend such large implants for patients as they inevitably are associated with early relapse and potential complications related to the size and weight.

F. True Lansden, MD · Answer

Thank you for you question.  Yes, placement under the muscle will give you a smooth transition.  However, I would urge you to reconsider the size of your implants.  800 cc's is awfully large for someone who is 5'4" and 125 lbs.

I am getting 800cc round silicone implants. Can they be placed under the muscle? 5'4", 125lbs

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