What Type and Size and Placement of Implant is Right for Me?

I'm 5'11 & 132lbs. I'm wondering what size implant is right for me as I have a thin frame I worry about the implants looking unnatural but would like to be a D. Also I have one breast that is smaller than the other, is it true this could only be fixed with saline implants? I've heard silicone may be better as I've not much breast tissue and the chance of seeing rippling would be higher. I'm a personal trainer and fitness instructor so I'm wondering 'under' or 'over' the muscle? I work out a lot.

Doctor Answers 6

What Type and Size and Placement of Implant is Right for Me?

You post a few issues. So if you were my patient based only upon the written history here I would recommend differing sized silicone Memory gel implant above the muscle. But best to seek a few in person opinions to fully understand the issues. You are in my opinion in correct about the ripplling with silicone I find it occurs more in saline implants. 

Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Correct type and size of breast implants

When considering breast augmentation, a patient and her sugeon have a number options from which to choose.  Your frame and symmetry do need to be taken into consideration in choosing what size, shape, and type (saline vs silicone) implant would give your the best result.  Placing implants below the Pectoralis major muscle and/or the use of silicone implants can help reduce the risk of the appearance of ripples.  However placing a large implant in the sub muscular plane may create problems when doing vigorous exercise as a fitness instructor.  Be sure to discuss these issues with your surgeon.  Also, try the implant size you choose on, in a bra.  This should help you in choosing an implant that will work best for you.  Best wishes.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Over vs. under athletic, thin patient

I think in your case you have to look at breast augmentation as risk management. That is, being thin and wanting relatively large (i.e. D cup) breasts, you are going have issues of side effects long-term (i.e. rippling, atrophy, asymmetry, excessive roundness, increased sagging over time, etc.). Since your final breast will be predominantly comprised of implant, your breasts will take on the characteristics and potential side effects of the implant. I doubt if you can get all your want for no risk. The fact that you are physically active may mean that under the muscle technique will pose dynamic side effects of distortion. There is no easy answer, and no right answer, you have to review all the pros and cons with your surgeon. In general, the smallest implant that will make you happy is the best and try to decide on what side effect you are willing to live with, including being smaller than you really want to be.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Saline vs Silicone and other issues

Hi there,

Regarding what's natural on you, it's possible that your thin frame will play a role.  The surgeon who sees you should measure your current breast width and this, combined with the amount of tissue you already have and your desired volume will tell the both of you whether you are pushing the limits on looking natural.  I feel strongly that patient should size in-office with real breast implants, but this is partly because in Northern California patients really prioritize a natural look and this is one way to be certain that the doctor and patient are on the same page regarding size.

Based on your description of yourself it does sound like silicone will be a better option, but in a consult and during the physical exam, your surgeon will let you know for sure.  It sounds like the size of the implant will be considerably larger than your existing breast tissue, so the actual % difference in breast size will be smaller after a breast augmentation.  You might do fine with silicone implants of the same size.

The pros and cons of over and under the muscle is a good discussion to have with your surgeon as well.  With wanting a natural appearance and being thin, it's likely that you will settle on under the muscle as best, even with a profession as a personal trainer.  Best luck to you!

Very best,

Dr. Mosser

Scott W. Mosser, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 9 reviews

Breast Implant Size, Position, Type?

Thank you for the question.

Having had the privilege of taking care of many “thin framed fitness instructors” I would suggest:  silicone gel implants  in the sub muscular ( dual plane)  position.   Different sizes (or even profiles)  of silicone gel implants may be helpful to improve symmetry.

Communication with your plastic surgeon will be critical to help you achieve your goals with the breast augmentation procedure. In my practice I find the use of goal pictures to be very helpful.     I have found that the use of words such as “natural” or “D cup” or "fake looking" or "top heavy" 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.

I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Implant selection

The only way to really size you up is to have an in office consultation. During the consultation your desires and your anatomy will dictate the best solution for you.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.