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Can you recommend natural looking implants?
If you have enough thickness of the soft tissue in the upper pole of your breast, then I would recommend textured silicone gel implants under the breast and in front of the muscle for the very most natural looking and feeling breasts. Unfortunately if your upper pole soft tissue is not enough to cover the ripples that are found with all breast implants, then you will need to have them placed under the muscle. In order to use the textured gel implants I would use a peri areolar incision and place the implant under the breast on the lower portion and behind the muscle in the upper portion, a dual plane.
There are several breast implants available for breast augmentation, with different sizes, dimensions and projection.
Choosing the right implant is very personal and depends on individual characteristics including, the measurements of your breast, the shape of the breast, the skin laxity and ultimately the desired look.
There are several things that contribute to a normal look with breast implants. The the first is in not trying to go too large and the second is in not forcing the projection. These can be controlled with a dimensional measurement process where the implant is selected based on measurements of your chest and breasts. Your other problem is that you are "very muscular" and "very physically active." The ideal placement of breast implants is below the muscle through a sub-mammary incision using textured implants This gives the absolute least capsular contracture and also contributes to a normal appearance. However, in you I would place the implants over the muscle to prevent flattening of the supramedial area and more fullness infralaterally. You will also reduce other problems later.
Implant type, size, and placement all contribute to a natural appearing result with breast augmentation. The base diameter of the breast is the most important variable, and selecting an implant of moderate profile at the appropriate diameter is a good place to start. Subfascial is an option that might add a little bit of support as compared to subglandular but not as much as submuscular. Another technique called the split muscle method is sometimes a good com,promise for athletic women who need more upper pole coverage but don't want the animation problems. Round implants will be softer and move in a natural way but shaped (form-stable) implants may have the best overall shape for your own anatomy.
You sound like you could be an excellent candidate for breast augmentation because of your fitness and desire for natural breast appearance. I would however suggest that there is not one ideal looking implant. The best look is probably an orchestrated interaction of your skin, muscle and breast tissue plus the implant. Your plastic surgeon should examine you and discuss his or her recommendations, and your preferences.
I suspect that the most important consideration is avoiding overly large implants. They distort your tissues and can seem disproportionate. Beyond that, implant width and dimensions should match your chest wall, breast width, and overlying tissues.
Begin with one or more consultations. Best wishes.
Smaller breast implants in the 250cc range often look more natural. Round breast implants such as moderate profile plus can look more natural that shaped or high profile implants. Under the muscle has many advantages including more implant coverage which is important in a thin fit woman. Understand that implants will move with pectoralis muscle contraction.
Most important consult a very experienced plastic surgeon who does a lot of aesthetic breast surgery. The Smart Beauty Guide is a good place to start.
I particularly prefer cohesive gel texturized round implants in an ultra high profile, placed under the muscular fascia in average patients respecting the landmarks as the midline, the mammary fold and the anterior axillary line. We have templates available to show the patients in front of the mirror what works better in their case. Try to choose an ASAPS member plastic surgeon.
Breast augmentation surgery is very personal and the correct implant for you may be not the best for someone else who is the exact height and weight. To look natural you must selected a size which is correct for you breast base width. You can then select the best breast profile. I like round implants for most women but it depends on their wishes. Under the muscle looks more natural especially in the upper pole. However, when you flex your muscle the implant will move upward. For most patients this is not an issue. Good luck.
The best cosmetic result in any particular breast augmentation patient depends on a variety of factors, including: your individual anatomy, realistic expectations, a thorough discussion with the plastic surgeon about the options, and an understanding of the pros and cons of any particular implant choice. Proper sizing is not just about the number of cc’s. The thickness of your tissue, breast dimensions which include the width, height, and projection, as well as chest wall width all need to be considered when choosing an implant. Trying on implant “sizers” of various shapes and volumes while wearing a tight t-shirt, bra, or bathing sit at a preoperative visit will help you and your surgeon choose the optimal implant.
Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California