I Am Wondering if I Could Get Away with an Under the Muscle Implant with the Degree of Sagging I Have? (photo)

I'm 5'8, 29 yrs old, 140lbs, with an athletic build and would like to add curves but do not want to do a lift because I plan to have kids one day. I lost some weight that may contribute to the sag my breasts have and I was wondering if augmentation alone would have good results, or if the potential for the "snoopy nose" is high.

Doctor Answers 10

Under The Muscle Breast Implants Can Cause Snoopy Deformity

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Thank you for cementing your photograph and question.  Her question is a very important one because it is essential that you choose the right procedure to achieve the cosmetic result that you wish.

You do have mammary ptosis which is sagging of the breast and your nipple areola below your inframammary crease the crease beneath your breast.

If a breast implant is placed underneath the muscle the implant will be held high by the muscle and we'll push the nipple areola further down.  If this occurs it is called the "snoopy deformity" because when viewed from the side the implant causes a bulge above the nipple and the nipple hangs further down and this looks like the profile of the cartoon character snoopy.

If you definitely want breast implants placed under the muscle that is a submuscular augmentation mammoplasty, you will need to have a breast lift at the same procedure to lift the nipple areola and prevent the snoopy deformity.

I do agree with other doctors who have answered your question that a subglandular breast augmentation that is with the implant above the muscle should give you an acceptable cosmetic result if you do not want scarring associated with the breast lift.

Avoid implants in sagging breasts

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I recommend a new technique called The Ultimate Breast Lift. This technique uses a circumareola incision and an incision hidden in the shadow of the breast. The breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Unlike the Wise pattern, this technique does not result in a vertical scar, nipple numbness or the inability to breast feed. Most patients have increased nipple sensation and can breast feed after this procedure. Planning future pregnancies is not a contra-indication with this technique. I do not recommend implants since your breasts are already sagging. The added weight will make them sag even more and you will require revision. Best Wishes, Gary Horndeski, M.D.

Can I get away without a lift

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I understand not wanting the scars from a lift but I think that if you just have an augmentation you will not be happy aesthetically. If you are not concerned about that and would rather you just have volume, then you could "get away" with just having an augmentation and waiting until you had children to have a lift, but I wouldn't recommend it. Do it right the first time and then hopefully, after kids, you may just need a touch up mastopexy. Go for a consultation with a board certified plastic surgeon and get your options and go from there! ac

Angela Champion, MD
Newport Beach Plastic Surgeon

:( Getting Away with It :(

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This is one term that i have been taught throughout my training and career to avoid. A good surgeon should never seek to "get away" with a procedure, it universally implies and produces subpar results. Like many things in life, people are bettered served by making the appropriate decision. In your case you do have a mild to moderated degree or breast ptosis, either with subglandular or submuscle augment wth good release you possible could get away without having a snoopy dog deformity. However the trade is a breast that is low on your chest, does not hold up well and will need an extensive revision when you decide to have them fixed. My recommedation would be to proceed with a lift at the same time. Ultimately the scars will not bother you, but a poor shape and outcome from not havingt the lift will lead to a unsatisfactory result, in my opinion and experience.

Reps B. Sundin, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 29 reviews

Breast augmentation and lift

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this is a very common dilemma in patients requiring breast augmentation and lifting procedure. You would likely not be very happy if you underwent was a breast augmentation procedure as you certainly could use a breast lift. You may potentially be a candidate for a periareolar lift and augmentation which limits the scars to one at the edge of you areola which is very inconspicuous. Please see a board-certified plastic surgeon with expertise in this area to discuss these options.

Breast ptosis

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implants do not lift anything they augment the size of the breast - if you would benefit from a lift now (which you would) you will certainly after a pregnancy and implants now without a lift will only give you bigger droopier breasts

To lift or not to lift

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I agree with the others that after performing a submuscular augmentation that you will need a lift.  I do not personally like the appearance of a subglandular augmentation so would support your implant placement choice.

To lift or not to lift

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There are several ways to achieve an acceptable result and it depends on what you are trying to achieve. All of our efforts have their positive aspects and their negative aspects. One way to achieve good results are with implants that are partially under the muscle and partially under the breast(dual plane III). Another is to put on top of the muscle and use a fairly large implant. 

You will also have to realize that you will probably never have significant upper pole fill unless you have both an implant and a lift.

Above the muscle or below with a lift

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Tanks for your question. There are definitely differing views on the issue of above vs below the muscle. My thoughts are that if you have implants placed above the muscle with no other procedure, your breasts will hang lower on your chest almost regardless of the implant size you choose. The size of an implant should not be a way to get around a breast lift. I think you would do better with a sub-muscular placement with a breast lift to give more upper pole fullness and a more youthful shape. Either way you should chose a board-certified plastic surgeon who can show you before and after photos of patients similar to you with post-op results you would most like to try to achieve.

I wish you well

Dr. Edwards

Silicone implants best for on top of the muscle

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Since silicone implants have returned to the market place in 2006, we as plastic surgeons are relearning the best use of these devices.  With your body build and shape I would recommend silicone implants on TOP of the muscle, your result will be spectacular!  The feel and shape of silicone in women with your build is natural and stunning, I would not place them under the muscle for, you will end up with "4" boobs!

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.