For fullness on top: anatomical 350cc above muscle or round 325cc below muscle? Wanting a natural look.

Hello and thank you for your question.   The best advice you can receive is from an in-person consultation. 
There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.   Make sure you specifically look at before
and after pictures of real patients who have had this surgery performed by your
surgeon and evaluate their results.   The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Dear awolken9,determining the ideal breast size and matching that goal for the patient is the most difficult part of breast augmentation. It starts and ends with the patient. We have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements. Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If its too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match. Of all of my breast augmentation patients, everyone of them have been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

There are several advantages to placing the implant behind the muscle. You will have more natural looking cleavage, and you will get a better mammogram in the future. There is also less risk of forming a capsule around the implant when it is placed behind the muscle. A capsule is too much scar tissue forming around the implant. In extreme cases, this can cause the breast to feel firm.A tear drop implant has the disadvantage of the possibility of turning within the pocket, making the breast have an odd shape. A tear drop is always textured which has been associated with BIA-ALCL, a very rare lymphoma. Additionally, many studies have shown that neither patients nor their surgeons can tell the difference between a smooth round vs a tear drop shaped implant after surgery. Hope this helps, and good luck!

Hi and thanks for the question. There is a lot going on with this and very different consults. Here is what I have seen and the studies have been well done in this particular question more than a decade ago. The studies were done by John Tebbets MD from Dallas and Hammond MD. There are a few issues that have changed since then, read on below. Tebbets invented a Meghan style 468 the forerunner to our modern teardrop, his claim was more upper pole fullness and a more natural result. Studies were done by other doctors (Hammond) and published in our major journal showing that with CYScan this proved to not be the case, clinically and as plastic surgeons gained more experience we also found that not to be the case, the 468 was discontinued. All shaped implants that are cohesive wether round or teardrop maintain upper pole firmness better today than their softer counter parts. Simply a matter of a stiffer filler. This comes with some trades and it holds true wether under or over the muscle.  The placement decision should be based on where your nipple is positioned with you standing upright and all things being equal should go under the muscle ad it decreases some of the other risks associated with implants. Today most surgeons including myself would not use a teardrop implant, because they are textured and carry a higher risk of a non Hodgkin's lymphoma, called ALCL. Allbeit rare it is something we have only seen with texture and all teardrops are textured. There may be some reason to use these but if a similar result can be achieved with smooth round implants I Would encourage you to use those. After having done many many thousands of breast augmentations, over 23 years, I have found that many of the same results can be achieved with various implants always make decisions that lead to the lowest risk and the highest predictability. I hope that helped !

Thanks for your question. I tend to like the round implants to provide more fullness at the upper poles of the breasts. The teardrop-shaped implants are, by their design, less full at the top. I hope that helps a little. Best wishes.

Thank you for your question.  For upper pole fullness, round implants are best; Teardrop shaped implants are bottom heavy and won't give you as much fullness on top as much as round implants.  Also, placement of the implant under the muscle gives a more natural result and has less of a risk for capsular contracture.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck! 

I prefer smooth round under the muscle.  Hard to say though without seeing a picture or examining you in person for a consult.  I do NOT recommend the teardrop at all. They turn and shift over time in my experience.   I use the Allergan Inspira implant either the smooth round moderate or full and my patients are very happy. This is my go to implant.  Make sure to see a board certified plastic surgeon and see lots of his or her before and after pics.  Good luck!

Thank you for your question. There are pros and cons to each implant approach. Implants are typically placed under the muscle because this provides better coverage to reduce implant visibility and reduce capsular contracture (abnormal scarring) and mammogram interference. However, it often produces an animation deformity which is a displacement of the implant when the chest muscle contracts and can be quite disturbing, especially in thinner women, where coverage is needed the most.The alternative is to place the implant above the muscle, which eliminate this deformity but allows less coverage over the implant. Capsular contracture is thought to be higher also but textured implants may help to reduce this risk. The biggest concern with textured implants, however, is breast implant associated lymphoma, which has been in the press lately, but it's risk is extremely low.One final option is to place an implant above the muscle and combine it with fat transfer. This would allow better coverage and also fill the breasts, especially in areas where an implant simply cannot reach, such as the upper pole and cleavage areas.In any case, I would recommend a consultation with a board certified plastic surgeon who is experienced with these techniques. I hope this helps and have a wonderful day! Dr Kayser - Detroit

Hopefully you have shown your surgeon photos of the post op look that is your goal because your words are confusing. "Full on top" and "natural" are opposites. Teardrop or Anatomic implants are designed to be natural and LESS full on top. The best way to maintain upper pole fullness is with a round implant filled with the newer and more highly cohesive gel. Even though more upper fullness does not have a natural look, it still needs To look nice and that requires placement under the muscle.