Submit your question below about any cosmetic procedure to be considered for posting with an answer from one of our board-certified plastic surgeons.
Note: ASAPS cannot give advice about specific medical problems nor should answers provided by responding surgeons be substituted for a complete medical history, work-up and an in-personal medical/surgical consultation. Sorry we can't answer all questions. We try to select questions that have the widest general interest.
I am a 20 year old athletic women looking for larger breasts. I am currently a...
For someone that is small breasted to start with, there are advantages to placing the implants submuscularly. First, the more coverage (breast tissue) you have, the less likely you'll feel rippling or knuckling of the implants. Second, data suggests that there is less risk of capsular contracture (hardening) of the implants when the implants are placed under the muscle. Third, it is easier to mammogram and see the breast tissue when the implants are under the muscle. However, irregardless of the position the implants are placed, one should get whatever mammographic views are needed to make sure the breast tissue is adequately visualized. Bottom line, you don't want to miss a breast cancer, so get whatever views you need.
I am a firm believer in providing good coverage for a breast implant in an effort to yield a more natural look; therefore I commonly place implants in the partially sub-muscular position. This is especially true in a thin woman with limited breast tissue to start with.
I hope this helps.
In my opinion, it is always better to have a pre-pectoral implant, whenever possible. This is especially true with athletic women. Placing an implant behind the muscle means that your implants are subject to the deforming forces of the muscle, which may give a suboptimal result when contracting the pects. It can also lead to lateral migration of the implants.
The problem with going "pre-pect" is that it is better done using a cohesive gel implant or silicone implant. Saline-filled implants are prone to unsightly rippling in the pre-muscular position.
You should find a surgeon who has experience with saline, silicone and cohesive gel (anatomic) implants and discuss the options with him/her.
There are advantages to subpectoral placement and advantages to subglandular placement. Subglandular placement entirely eliminates the possibility of implant animation with contraction of the pectoralis muscle. If you are athletic and exercise your arms a great deal, depending on how much myotomy of the lower portion of the pectoralis origin is performed, you will have some movement of the implants (and thus the breasts) upon exercise if the implants are deep to the muscle. If you are very lean and small breasted, the implants directly beneath your skin (subglandular) will be more obviously visible as implants in the subglandular position. If you are lean and choose saline implants, subglandular placement is not recommended in my opinion because of the unavoidable rippling, wrinkling, and edge visibility that will result. Mammography is a factor to consider, but at age 20, unless you have a family history of breast cancer, is less important. Discuss this issue with your surgeon, or perhaps several surgeons. Every woman and every situation is different. Your anatomy and personal preferences should be individually considered in this decision.
There is no "better" placement position. There are advantages and disadvantages to placement above or below the muscle.
Above the muscle will have less pain around the time of surgery, less bleeding at the time of surgery and the implants will not move or be deformed with muscular activity. In some patients the implants may sit in the breast tissue better on top of the muscle (like if there is some drooping of the breasts).
The down side is that there may be more visibility or feeling the ripples of the implants, more chance of capsular contracture and a slight increase in the risk of infection around the time of surgery.
Under the muscle - more movement of the implant with muscular activity, more bleeding at the time of surgery, more pain with the surgery; less visible and palpable ripples, more natural look in some cases, less infection, less capsular contracture.
A discussion with your surgeon will lead you to the correct decision for you. Many surgeons have their preferences and you should be comfortable with their decision based on experience even when two plastic surgeons may have opposite opinions.
Subpectoral placement is the ideal position for an athletic woman with small breasts to start with. Silicone would provide the most natural result for a small breasted woman. Silicone breast implants are available to women ages 22 and older. At age 20, silicone implants are not an immediate option. You may want to consult with a plastic surgeon to determine which implants you think would be ideal for you. Consider waiting for silicone implants. Breast implants are designed for life, not just a year or two.
If you have very little breast tissue you may do best with a submuscular breast implant pocket. The muscle provides coverage for the breast implant and some studies show a lesser capsule rate for the first few years.
If you have a sufficient amount of breast tissue, which may be the case with a B-cup breast, then I prefer a subglandular (above the muscle) implant pocket in young athletic women.
This is because it does not subject the breast implant to the stress of repeated squeezing during sports activities like tennis, golf, and weight lifting.
I am offering a temporary all-inclusive fee of $4999 for breast enlargement surgery-my fee, the MD anesthesiologist, the operating room, and the costs of the implants. Watch my video and see my website(surgery-plastic.com). Dr. Ed Domanskis;Newport Beach,California
Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery 1441 Avocado Avenue, Suite 307 Newport Beach, California 92660 949.640-6324/1.888.234-5080(Ca) FAX- 949.640-7347 Website: http://www.surgery-plastic.com Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine) Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors Plastic Surgery- 2005/2006/2007/2008/2009 President,American Society of Bariatric Plastic Surgeons www.ASBPS.org
There are actually several options that you should consider. The first consideration of course is size, because larger implants are not as compatible with an athletic lifestyle. More importantly though is that with placement under the muscle, athletic women are at higher risk for what is called animation deformity. On the other hand, going over means less coverage, which is also an important issue with an athletic build. Options you may wish to consider are subfascial, or split submuscular, which would prevent the animation problem but add some coverage or support where it is most needed.
I have augmented many athletic women with subpectoral implants with excellent results. The implants hold their shape better long term, there is a lower risk of capsular contracture, and they are not inhibited in their training when the pocket is made correctly. Subglandualr placement is probably ok with smaller implants, but most women want at least 300 cc in Southern California. Discuss with your surgeon. Every case must be customized, but I prefer submuscular (subpectoral) placement.
Jay Calvert, M.D., F.A.C.S. - Beverly HIlls and Newport Beach, CA
When possible I always prefer to place breast implants beneath the chest muscle. There are significant advantages to sub-muscular placement including less risk of capsular contraction, better coverage and hiding of the implants, and more reliable mammograms in the future.
Many patients worry that during athletic events and vigorous work outs the contraction of the chest muscle may cause the implant to move and look abnormal. In my experience this is rarely if ever a problem unless you are a professional competitive body builder competing in a bikini top.
In fact I have had professional bodybuilders who has had sub-muscular breast augmentation and I do not find a detraction.
Placing an implant in a submuscular or subglandular pocket so far is Conley governed by the amount of tissues you have and the size you choose to insert. The main goal is to have a natural looking and feeling breast. Evidence about capsular contracture rates in each pocket has been controversial and so far all we know about the causes of this complication are just theories. In an athletic lady like yours who is looking for a reasonable increase in cup size I would advise with a subglandular pocket as the recovery is much faster and the pain is much less in this type of pocket.
Shady Hayek, M.D.