Thoughts on what kind of implants would best suit my body? (Photos)

Question

I’m 5’1, I weigh 108 I would love implants but I’m not sure if UTM or OTM would suit best , or what kind of implants as well

Safa Sharabi, MD · Answer

Hi there,
I think you would have a great result with UTM or OTM, but in your case I may steer you towards under the muscle. Specifically, this is because of the slight indentation on the upper outer aspect of your left side towards your armpit. In my experience, an under the muscle approach does a better job a smoothing out that corner. On your right, I would do a dual-plane augmentation with would potentially help lift your right nipple to match your left, which is just a touch higher. In terms of implant type, a smooth round gel or nano textured implant would work well. They have slightly different benefits that you should definitely ask about during your consultation. I hope that is helpful! 
Happy to help however I can!
Sincerely,
Safa E. Sharabi, MD

David Mateo de Acosta Andino, MD · Answer

Choosing between over-the-muscle (subglandular/subfascial) and under-the-muscle (submuscular or dual plane) breast augmentation really depends on your anatomy, lifestyle, and the type of result you’re hoping to achieve. At 5’1” and 108 pounds, you have a smaller frame and less breast tissue, so implant selection and surgical planning become especially important in creating a balanced, natural-looking outcome.
When deciding on implant placement, I typically encourage patients to think beyond just “what is technically best” and instead focus on what fits their body and lifestyle. For example, if you are very active or regularly use your chest muscles for activities such as weightlifting, CrossFit, yoga, tennis, or certain jobs that involve repetitive upper body movement, over-the-muscle placement can sometimes be a better option because it avoids animation deformity, where the implants move or distort slightly when the chest muscles contract.
I also spend a lot of time discussing aesthetic goals with patients because there is not one single “correct” type of augmentation. I often ask patients to bring wish pictures so I can better understand whether they are looking for a softer, more natural enhancement or a fuller, more augmented appearance.
Based on your height, weight, and the photos you posted, you may be a very nice candidate for the Motiva Preserve technique using Motiva Ergonomix implants if your goal is a more natural shape and feel. Ergonomix implants are designed to adapt more naturally to movement and body position, which many patients appreciate when they want a subtle, elegant enhancement rather than a very round or obviously augmented look.
On the other hand, if you prefer a fuller upper-pole appearance or a more dramatic enhancement, Motiva Round implants combined with additional internal support, such as an internal bra technique, may be a better fit for your goals.
One of the most important things to understand is that breast augmentation is highly individualized. There are certainly “textbook” answers in plastic surgery, but you aren't a book, you're a person. The best surgical plan is the one that matches your anatomy, lifestyle, tissue characteristics, and personal aesthetic preferences. I always recommend reviewing extensive before-and-after photos of different implant types, profiles, and placement techniques to help determine which results resonate most with you. What looks perfect on one patient may not feel right for another, and that is completely normal.
A thorough consultation with a board-certified plastic surgeon who can evaluate your tissue quality, chest dimensions, skin elasticity, and goals in person will ultimately help determine which approach will give you the safest and most satisfying long-term result.

Natalia Vidal Laureano, MD, FACS · Answer

Thank you for your question! Implant placement and implant type are some of the most common questions patients have when considering breast augmentation, and it’s normal to hear different recommendations from different surgeons based on their experience and approach.

In your case, since you have good natural breast tissue and coverage, I think you would be an excellent candidate for a subfascial breast augmentation. This means placing the implant over the muscle but beneath the fascia covering the muscle. This approach provides good support and a natural appearance while avoiding “animation deformity,” where the implant moves with muscle flexing.

You also have a very good nipple position without significant sagging, so I do not think you need a breast lift or an under-the-muscle approach.

Another advantage of subfascial placement is usually an easier recovery with less discomfort since the muscle is not being disrupted.

For implant type, I would recommend a cohesive silicone gel (“gummy bear”) implant, which tends to provide a softer, more natural feel and look. The exact profile and fullness can then be tailored to your aesthetic goals.

I hope this helps clarify your options!

Warren Schutte, MD · Answer

I recommend placing the implants under the muscle for breast augmentation.It is very important that you spend time using "size try-on systems" to see what cc size you desire.

Daniel Barrett, MD · Answer

Dear Loreee27,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, 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 it is 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, every one of them has 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.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert M. Lowen, MD · Answer

Dear Loree,
  You are not limited in the kind of implant you choose, nor limited in going OTM or UTM.   Sorry, not to simplify things by pointing you in one direction or the other.  You just need to know the pros and  cons of each so you can make the decision that best suits you.
  For example, criteria that are used include your breast and chest width:  yours are not narrow so you can have a full width, implant with moderate projection,  such as an Allergan Soft Touch, SSM moderate profile gel.
   You have moderate lower pole volume ad adequate nipple to fold distance,  so no problems there with respect to size of implant. And you need less volume since you already have a fair amount. 
    You appear to have 2 cm of pinch thickness above the muscle, so  you could go over the muscle without undue visibility, either subglandular or subfascial.  I go under the muscle since it conceals the implant as you get older and tissues thin, in some cases.
    When you get your in-person consultation, any particular concerns can be discussed, and you should do fine, if you stay within the breast footprint dimensions when you choose your size.  Either OTM or  UTM should give you a pleasing result.

Donovan Rosas, MD · Answer

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

•	Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster 
when compared to subpectoral augmentation.

•	Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

•	Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

•	Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

•	Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

•	Subpectoral implants have a lower rate of capsular contracture.

•	Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

•	The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.

I generally prefer an UTM approach in most cases both for the appearance and longevity of result.

As always, your board certified plastic surgeon (ABPS) can help guide you in your decision making process.

Gary M. Horndeski, MD · Answer

Your breasts are asymmetrical in volume, shape and position. One breast is higher than the other. You will need a circumareola approach to correct the areola position. In terms of implants, placing them in front of the muscle has a higher rate of capsular contracture than behind the muscle. I recommend small silicone gel implants placed retro-pectoral.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Under the muscle for the most natural look. Choosing the right size and profile breast implants for you. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gerald Minniti, MD, FACS · Answer

The last 5 years has seen a lot of published data showing improved outcomes with regard to lowering the risk of both capsular contracture and implant malposition with implants placed in a subfascial position. Further, Motiva implants have even lower risk for contracture as well. Placing implants above the muscle allows the muscle to retain its normal position and function, and prevents implant movement or deformity when the muscle contracts. The only limiting factor is tissue thickness. A skin pinch in the upper pole of your breasts should be at least 3/4 or an inch, or 2 cm for subfascial placement (OTM).

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