Breast Augmentation: Cost, Reviews, Photos

I believe that breast implant massage is helpful for certaintypes of implants. Textured surface implants are designed to be adherent to yourtissue and massage is not indicated.

I feel I have better results with smoothsurface implants. They feel softer and have less chance of rippling. I believesmooth implants do benefit from massage.

Massage is not quite the correct term.What we want you to do is breast implant displacement exercises which move theimplant inside the pocket and help maintain proper position of the implant anddecrease the risk of capsular contracture. I recommend this very early,starting the day after surgery. (John Squires, MD, Denver Plastic Surgeon)

Breast massage after augmentation

I only have my patients massage their breasts if they get smooth implants. You really don’t want to massage textured implants because you want the body to adhere to them. I

f you have the anatomic-shaped implants, you definitely don’t want to massage them because you could cause them to rotate and look strange. It’s best to ask your surgeon this question and find out what he or she recommends. (Victor Ferrari, MD, FACS, Charlotte Plastic Surgeon)

Implant Massage after Breast Augmentation

Your surgeon will instruct you on how to massage your breasts, how often to massage, and when to begin. Typically we instruct our patients to push side to side, downward toward the middle and then outward several times a day in the early postoperative period.

This can vary depending on each individual patient’s anatomy and situation. This helps the pocket that was created for the implant to remain loose and allows a comfortable space for the implant so that they become soft, stay soft, and are able to move around like natural breasts.

After everything has healed and the breasts have softened, patients massage once a day as long as they have implants. (Kelly E. Tjelmeland, MD, Austin Plastic Surgeon)

Breast massage of Implants after augmentation is individualized

It is important to follow your Plastic Surgeons recommendations following your breast augmentation surgery. My post surgery protocol involves integrating massage therapy with Vodder MLD (manual lymphatic drainage) by a licensed therapist.

This begins 3 days after surgery and continues for 6 weeks. This allows the therapist to manually but gently massage swelling fluid to the closest lymph nodes.

The therapist also educates my patients on how to massage their specific type implant based on the protocal I have in place for each type of implant.

Together we educate the patient about the individualized daily and long term care of the breast implants. (Laurie Casas, MD, Chicago Plastic Surgeon)

Breast implant massage

It is really unclear whether breast implant massage (technically breast implant displacement exercise) is beneficial- but since it doesn’t hurt, many of us recommend it. I personally have patients massage upwards 3 times a day. Some patients I will have massage inward if they want more cleavage, etc. (Frederick G. Weniger, MD, FACS, Hilton Head Island Plastic Surgeon)

Post-Op Breast Augmentation

Place your flattened hand on the breast implant and lean your body weight on it for a minute. The compression keeps your capsule stretched out so it doesn’t become contracted. (Mel T. Ortega, MD, Miami Plastic Surgeon)

Massage technique after breast augmentation

Massage techniques vary between surgeons and surgical technique. I advise most patient to massage their breast pockets medially and downward in a specific fashion. (Raffy Karamanoukian, MD, FACS, Los Angeles Plastic Surgeon)

How Do You Massage Breasts Implants After Breast Augmentation?

The main thing to keep in mind is to make sure you are massaging your implants only and not just your breast tissue alone. Your PS should have gone over the specific techniques with you. Its very important that these are done correctly.

The massaging is important for a number of reasons, lowers the risk of capsules forming around the implants, keeps the implants soft and subtle in the pocket and helps with tightness and swelling after breast augmentation. Make sure that you are moving the implants and not your own breast tissue.

Make sure to use your opposite hand/palm to massage the opposite side. In other words, use right palm on left breast and left palm on right breast, push up on the implant, watching for it to square off or round at the upper portion of the pocket then watch the implant come back down.

Start slow and moderate, do five reps, twice a day, each breast. Again, check with your PS to make sure you are doing them correctly. (Shelby Brantley, MD, Jackson Plastic Surgeon)

Implant placement. Above or Under Muscle

Most plastic surgeons prefer to place the implant under the pectoralis major muscle. They tend to look more natural as there is more tissue on top of them.

They usually have a decreased rate of capsular contracture. They typically have a decreased rate of sliding down the chest wall.

Each patient is different. Each plastic surgeon is different. Best to see three board certified plastic surgeons. Bring photos of what you might like.

Please have reasonable expectations. Together with the plastic surgeon, you will be able to make an informed decision. (Jeffrey Roth, MD, Las Vegas Plastic Surgeon)

Above or Below the Muscle for Breast Implants

The advantages of placing implants below the muscle are as follows:

1. More coverage and less implant show and rippling at the top of your breasts
2. Lower rate of capsular contracture or hardening of your breast implants over time.
3. Slower rate of thinning of your existing breast tissue since most of the weight or pressure of the breast implant is behind the muscle
4. Easier to obtain accurate mammograms

For all these reasons, the majority of our breast augmentation patients in Jacksonville have their breast implants placed below the muscle (i.e. 2/3 under the muscle, 1/3 under the gland). I would recommend your undergo breast augmentation under the muscle. (Ankit Desai, MD, Jacksonville Plastic Surgeon)

Breast implant placement – Over or under the muscle?

Breast implants can be placed either over or under the muscle with good results either way. For saline implants, whenever possible, I prefer to put them under the muscle.

The reasons are that there is less chance, although not zero chance, of developing palpable rippling or wrinkling of the implants. Also, under the muscle, the implants are massaged each time you move your arms, which will help keep them softer. However, if your muscles are tight, it may not be easy placing 450 cc implants under the muscle. In those cases, you might need to have them on top of the muscle. (James Tang, MD, Houston Plastic Surgeon)

Over vs. Under the Muscle: an Easy Choice

Mother Nature put your breasts over the muscles, so why would the plastic surgeon place the implants under?

Here’s why: the results are more natural in appearance, the implants are less apparent to the touch, there is less tendency to form troublesome scar tissue and mammograms are easier to perform.

However, it is sometimes necessary to place the implants over the muscles, especially where there is a great deal of sagging and the patient does not wish a breast lift.

An experienced cosmetic breast surgeon will help the patient reach the best decision. (Eric Pugash, MD, Vancouver Plastic Surgeon)

Over or unders: In a “pinch”! Breast implant placement

It appears that the vast majority of surgeons tend to favor the submuscular placement due to concerns with mammographic imaging, lowered incidence of capsular contracture and improved upper pole contours in thin patients with small breasts and skin pinch of less than 2.0 cm. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

Breast Implant Placement Choice: Above or Under the Muscle.

Breast Implants can be placed in three breast planes: above the muscle (subglandular), below the muscle fascia (subfascial), and below the muscle (subpectoral).

There are indication and advantages for all three with the most common being the subpectoral plane which places the 2/3 of the implant under the chest muscle with the lower 1/3 under the glandular tissue.

The advantages are a more natural upper breast shape and less implant scarring with the disadvantages being longer recovery and some animation deformity with muscle flexion.

Advantages of Breast Implants Placed Below Muscle

There are advantages to placing breast implants below the pectoralis muscle. These include a “more normal” appearing and softer breast. Rippling of the implants is less likely and less visible as well. The primary disadvantage is more discomfort in the immediate post-op period. (John Whitt, MD (retired), Louisville Plastic Surgeon)

For most of my patients, I recommend placement of breast implants below the muscle for a few reasons – they tend to look a little more natural because the muscle provides an additional layer of tissue between your skin and the implant.

These means the implant will be less likely to be obvious, palpable, or rippling felt.

Additionally, the studies show there is a lower incidence of some complications when an implant is placed below the muscle – specifically capsular contracture.

There is likely a lower chance of development of biofilm (bacteria) on the implant (which is one thing the contributes to capsular contracture) when we avoid going through the breast tissue and go straight under the muscle.

If you can decrease the risk of complications, then that’s they way I tend to go! There are of course some downsides to under the muscle (such as longer recovery due to muscle spasm) but I find they aren’t as significant to most patients compared to reducing the complication risk.

As far as your picture, it does look like there is a slight asymmetry to the breasts. It is normal for most women to have some differences from side to side and they can sometimes be improved with the surgery. Definitely something to discuss with your chosen plastic surgeon. As for choosing a surgeon, please make sure that anyone you are consulting with is a board certified PLASTIC SURGEON – this is critical!

Your surgeon should definitely allow discussion of any topic regarding the surgery that you would like, especially your goals and implant type/size. Make sure once you have found board certified PS that you choose the one with whom you feel most comfortable. You want to trust your PS implicitly! (Megan Jack, MD, Boca Raton Plastic Surgeon)

For numerous reasons, submuscular breast implants placement is preferred. I personally do not place them on top. I would offer that approach to you, take measurements and have you use a sizing system. (Michael Hueneke, MD, Nashville Plastic Surgeon)

Under the muscle would be appropriate. Your implants are used to increase your breast volume and shape. They’re not used to create cleavage. Your second surgeon sounds like he or she is on top of things. (Earl Stephenson, Jr., MD, DDS, Atlanta Plastic Surgeon)

Implant placement best under the muscle.

For many reasons, I prefer implant placement under the muscle. Done properly cleavage is achievable and the implants do not move toward the armpit. Implants move toward the armpit if the pocket is dissected to far that way. Measurements and analysis of the breast should be done so an implant with a diameter close to the breasts diameter is chosen. Choosing an implant with a diameter much larger than the breasts diameter will result in predictable problems in the future due to disruption of the breasts natural boundries. Volume of the implant should be chosen by the patient after proper sizer evaluation. More consults may be helpful but measurements should be done and what they mean explained to you. (Jeffrey M. Darrow, MD, Boston Plastic Surgeon)

Under vs Over the muscle breast augmentation placement

Under the muscle is done for 3 main reasons .

1. better for mammography in the future which should be your primary concern
2. decreases ripple visibility in the upper poles and
3. creates an auto massage for implant that decreases capsular contraction or scar tissue around the implants. In my practice I rarely place implants on top of muscle except in severe 2nd or 3rd degree ptosis where the patient does not want a lift .

And I try to place upper implant under the muscle. 400cc is a nice choice and should possibly give you and entry level D cup. But I do not guaranty cup size, only implant size. Trying on implants is standard in my practice using soft bras and allowing you to visualize your selection. Your breast hang slightly lateral-to the side and will postoperatively in any surgeons hand. (David Liland, MD, Dallas Plastic Surgeon)

Above or below the muscle

Your breast tissue is a little lower than the muscle so if you did have it placed under the muscle, and used the nipple as the bulls-eye, you would have only a small percentage of the implant below the muscle.

If you had the implant placed higher to have more implant beneath the muscle, then you would need to have a breast lift along with the implant. (Julio Garcia, MD, Las Vegas Plastic Surgeon)

Should my implants be over or under the muscle?

Well it certainly sounds like you are doing your homework. I look at your problem a little differently. You haven’t said whether or not you want upper pole fullness and how far laterally you want the implants to be.

Knowing your height and weight would be helpful as well as you breast measurements including sternal notch to nipple, nipple to inframammary fold, and base diameter. I would probably recommend a shaped silicone gel implant like the Natrelle 410 full height full projection implant.

Oh course this is just based on your pictures and by no means is this to be interpreted as a consultation which would only be done by evaluating you in person. (Steven Schuster, MD, Boca Raton Plastic Surgeon)

Dual plane breast implants placement

The dual plane technique is currently favored and it places the implant partially under the muscle and partially under the gland. This avoids an unnatural stepoff in the upper pole which may happen if you have very thin tissues. Also, capsular contracture rate is improved by being partially under the muscle. (John Michael Thomassen, MD, Fort Lauderdale Plastic Surgeon)

Pocket breast implants placement

There are many considerations when deciding upon pocket location. There are patients for whom a subglandular or subfascial pocket is preferable and there are some patients for whom a dual place pocket is preferable.

For many patients there are simply pros and cons to the pocket choice – see the link below for this in table form. When choosing an subglandular or subfascial pocket I believe that a textured implant is preferable. (Michael B. Tantillo, MD, Boston Plastic Surgeon)

In my opinion I recommend unders in 98% of my patients even those like you with widely spaced anatomic breasts. I also recommend moderate profile + implant, as for size maybe a 400 to 450 cc.

Also you are smart to obtain at least 4 to 6 in person consults if the issues of size and placement is troubling you. (Darryl J. Blinski, MD, Miami Plastic Surgeon)

The good news is that you will likely get a great result regardless of which breast augmentation option you choose. I do feel strongly that breast size desire and breast dimensions should be discussed and measured, respectively. Choosing the appropriately sized and shaped implant is the most important decision that you will need to make.

Of course, each surgeon has his/her own way of doing things so you will get different recommendation. For example, I would probably go with a shaped implant either on top or under the muscle. My reasoning for that is because your breast seem a little lower down on your chest and I would want to height of the implant. If your areola size bothers you then this may be a good time to do an areola reduction and breast augmentation at the same time. (Remus Repta, MD, Scottsdale Plastic Surgeon)

Under the muscle is better for almost all patients in my opinion, even those that are extreme exercisers.

Mammograms are better, there is less scar tissue and the tissue coverage is thicker making them look better.

Whether you call it “submuscular”, “partial submuscular” or “dual plane”, it is all the same. (Richard P. Rand, MD, FACS, Atlanta Plastic Surgeon)

Over or Under the Muscle

Without question, you should have your implants placed beneath the muscle. The upper pole of the breast is the area with the least amount of breast tissue, and often the area where women want additional fullness.

Placing the implants above the muscle will result in increased visibility of the implant in the area where most people will see in a bikini or V neck type top. You want the most amount of tissue above the implant to help camouflage the transition from the chest to the breast.

There are other benefits including less of a risk of capsular contracture and better breast cancer surveillance. Take a look at my blog post (below) detailing the pros and cons of this very common dilemma. (Vincent P. Marin, MD, San Diego Plastic Surgeon)

Above or below the muscle breast augmentation

In general, under the muscle provides an added layer to minimize the “bubble” at the top. I compare it to a quilt on a bed which hides the underlying irregularities of the sheets and mattress. In thin women or those with little breast tissue, over the muscle may produce the “cantaloupe” look, which is not natural-looking. With proper nerve blocks and the use of a pain pump for 2-3 days post op, my patients have had improved pain tolerance post operatively. (Ricardo Izquierdo, MD, Oak Brook Plastic Surgeon)

Over, under, or in-beween: how to decide on breast implant placement

You are no doubt familiar with the benefits and drawbacks of each approach: under the muscle gives better coverage and more natural appearing contours on the upper portion and inner portion of the breast when there is a thin fat layer under the skin. This is something your plastic surgeon can assess more accurately than any of us looking at a picture, but it does appear that under would look better in your case.

This is more important when you are going fairly large as you are planning to. The disadvantages are that recovery is a bit longer, and you may get what are called “animation deformities” when going under. This can be avoided by a split muscle approach where you have upper and inner coverage but don’t cut the muscle as with the dual-plane. (Richard Baxter, MD, Seattle Plastic Surgeon)

Implant position

I prefer to place the majority of implants under the muscle. Of course this really means that the upper 2/3 or so are covered by muscle. This will provide extra coverage over the implants. (Steven Wallach, MD, Manhattan Plastic Surgeon)

Over/ Under for breast implants.

I would say under the muscle would be better, and in general that is where I prefer to place breast implants for augmentation. Regarding the size you have not provided measurements so it is difficult to tell if that implant size is reasonable. (Walter D. Gracia, MD, Fort Worth Plastic Surgeon)

Breast implant placement: over or under the muscle

In general, and I think under the muscle will give you the best chance at an outstanding result, with less risk of noticing rippling, especially at your cleavage line. There are certainly a few situations where placing the implant in front of the muscle, but in most patients, in particular those who are quite thin such as yourself, I would place the implant behind the muscle. (Shahram Salemy, MD, FACS, Seattle Plastic Surgeon)

I have been doing this over 30 years, your breast tissue is over the muscle – you need to replace it, Nice silicone implants over the muscle will be the best in my hands. No one puts the implant entirely under the muscle anyway, it is a ” dual plane” where the top half is under and the bottom half above.

If you are active and exercise, the upper muscle can deform the implant and make it look wierd. When all we had were saline implants that rippled, under worked well. Now with the silicone, over is best as far as I am concerned. (William B. Rosenblatt, MD, New York Plastic Surgeon)

Under the muscle for augmentation

Generally, this is the more preferable location. The more tissue covering the implant, the less the chance of visible rippling or palpablility. It also puts the implant in a slightly different plane for mammography. (David A. Lickstein, MD, Miami Plastic Surgeon)

I recommend under the muscle placement of breast implants

In general, most patients should go with under the muscle placement. Generally above the muscle placement is reserved for patients who exercise every day, such as weightlifters.

Below / under the muscle is done for the majority of patient, since you will end up with a more natural feel and have less rippling and wrinkling. (Roy Kim, MD, Seattle Plastic Surgeon)

Implants over or under the muscle?

I would place implants beneath the muscle. You are thin, and I would want as much coverage over those implants as possible to reduce the risks of wrinkling and rippling. You will also have a slightly lower risk of capsular contracture by placing the implants beneath the muscle. In my opinion, there is just no good reason to place your implants above the muscle.

Please be sure to see only surgeons who are certified by the American Board of PLASTIC Surgery (NOT a ‘cosmetic surgeon’, as they are typically not plastic surgeons at all!). (Carmen Kavali, MD, )