Breast implants can look natural both under and over the muscle

Breast implants can look very natural in either position. There are several factors which influence whether or not the implants look natural: 

1) How much tissue the patient has overlying the implant. 

I recommend that  thin patients whose ribs are showing have the implant under the muscle. When the implant in under the muscle, the upper, inner half of the implant is covered by the muscle, not the whole implant. By placing the implant under the muscle, extra "padding" is provided over the implant over the upper, inner part of the implant where the patient's own tissue tends to be thin.

2) Whether or not the implant looks natural is affected by whether or not the implant has a capsular contracture;.

3) Implants that are too large for your frame will not look natural.

The benefits of under the muscle placement outweigh the downsides.
First, when I talk about under the muscle, I am talking about a dual plane technique whereby the lower part of the implant is under the breast tissue and the upper part of the implant is under the muscle. If the implant is placed under the entire muscle, the implant is typically pushed out and down, spreading the cleavage unnaturally wide.
Second, the benefits of placing them in the dual plane position are many. a) decreased capsule contracture (hardening of the implants) when compared with above the muscle. b)Smoother implant edges to give a more natural result when compared with above the muscle implants. c) Less sagging over the long term. Face it - implants add weight and stress to your breasts that will add to the downward pull over time. When the implant is above the muscle, the breast tissue does not offer much support against the ravages of gravity. In contrast, the muscle on top of the implant adds significantly more support which bodes well for a more natural and durable result.
So what are the downsides to placing the implant behind the muscle. a) It hurts more during the postoperative period. b) some patients experience funny breast movements when they are contracting the chest muscles forcefully.
Would I ever place the implants above the muscle? yes, I will place them in front of the muscle in patients with Tubular breasts as part of a procedure to change the shape of an abnormal tube shaped breasts. I will also place them in this position for professional body builders.
Many doctors suggest placing the implant under the gland to improve a sagging or ptotic breast. I am opposed to this technique and suggest a lift for this problem. It is simple, if you are sagging - Fix the Sag.

12 of 13 found this helpful

Helpful?

Contact the doctor

We women are incredibly aware of our breast appearance-- maybe even more than men are. Breasts are sexual and sensual, a big part of what makes us women, and they can dictate our sense of attractiveness and desirability (for better or worse). Breast augmentation is one of the top three most popular plastic surgery procedures performed. So many women embrace this procedure because it carries little risk of complication. And because an implant can be inserted through a tiny incision in the navel or armpit (and moved into place under the skin), or under the areola or breast, it's a quick, nearly scarless operation.

A major factor that effects how breast implants look and feel is whether they're inserted over or under the chest (pectoral) muscle. Traditionally I do a submammary implant, inserting the implants under the breast tissue and over the muscle because it's technically a lot easier (displacing the chest muscle requires a little more delicacy). It's also quicker: I insert the implant through an incision in the navel, nipple, breast fold, or armpit, place it over the muscle, and then inflate it when it's snugly in place. The result is fabulous: perkiness with barely a trace of scar.

If you want the most natural-looking breast you'll need a subpectoral implant, in which the implant is placed under the muscle. This procedure also requires the merest incision- about three centimeters in the crease under the breast or at the edge of the nipple-- and diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant which occurs in 10 to 30 percent of cases.

Subpectoral implants aren't right for everyone, though. If you have saggy breasts, and implant placed under the muscle won't fill out that empty breast sack, and you'll get what we call the "double bubble" look, where the implant is situated next to your armpit and the breast hangs several inches below it. Instead, you can have a procedure called augmentation mastoplexy, in which the implant is placed under the muscle and the skin on the breast is lifted and tightened.

In short, you must know--realistically-- what you are starting with, as well as what you want to look like when surgery is done. Do you care more about the placement of the scar or about a quick painless procedure? Do you want a natural appearance or a round, perky look? These are some of the factors I weigh with my patients when evaluating what type of procedure to do.

11 of 13 found this helpful

Helpful?

Contact the doctor

Emzy,

This is a great question and you will likely hear many different opinions from many different people. That is because there is not a definitive answer and, depending on your body, the answers may be different.

Basically, the implants can be placed above the muscle (below the breast) or below the muscle (and the breast). The implant needs to have a sufficient amount of natural tissue covering it to maintain a natural shape. If you do not have much breast tissue and you put the implant above the muscle, then you will be able to see the implants and it will have an unnatural shape. In this situation, then placing the implant below the muscle gives more tissue coverage and a more natural shape. If you have plenty of breast tissue, then placing the implant above the muscle may be a nice option. However, if you have lots of loose breast tissue, then you may need the implant and a breast lift at the same time. In this case, it would be best to put the implant under the muscle and then perform the breast lift. My best advice for you is to go to a few consultations and see what the surgeons have to say. They will be able to give you good advice based on your body shape and amount of breast tissue.

I hope this is helpful.

David Shafer, MD
Shafer Plastic Surgery - Manhattan

5 of 5 found this helpful

Helpful?

Contact the doctor

but Emzy nothing in breast surgery can be done in a word.  In general, because under the muscle placement provides an extra layer of tissue over the implants they are less apparent as implants.  It's like placing a comforter or blanket over a golf ball compared to placing a sheet over a golf ball, try it yourself.  Although this also generally results in a more "natural" appearance, it is not for everyone and many patients look just as natural with implants above the muscle.  A consultation with your board certified plastic surgeon will delineate the pros and cons of each placement position based on your needs and body characteristics.  This is a very individualized choice and all factors of your situation must be addressed to properly advise you of where to place your implants.  Good luck!

5 of 6 found this helpful

Helpful?

Contact the doctor

A natural breast appearance can be achieved but is based upon many factors.  Here are a few.  Overdoing the volume or shape of the implant may make it look worse.  Having good soft tissue coverage improves the apperance so more often than not, under the muscle looks more natural. 

2 of 2 found this helpful

Helpful?

Contact the doctor