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Is Above Muscle Breast Implant Placement the Best Approach?

I am 37 years old and have nursed my 3 children. I used to be a C cup, but now my breast are just "empty" and saggy. My surgeon says I am not quite needing a Breast lift, but is recommending Silicone Breast Implants above the muscle. I don't know anyone with implants above the muscle. Is this the right approach?

Asked 30 months ago by weejo0 in Kansas City, KS

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age 35-44 breasts female above muscle breast feeding sagging C cup

Under the muscle is best

Surgeons are divided on the topic of implants on top of the muscle vs. under the muscle. There are several disadvantages of implants on top of the muscle including more sagging over time, easier to see and feel the implants, higher risk of capsular contracure, higher risk of rippling, more interference with visualizing breast tissue on a mammagram and more risk of the nipples losing their blood supply with a future breast lift. These problems far out-weigh the scars from getting... more

James McMahan, MD

Columbus Plastic Surgeon

ASAPS ASPS

Breast Implants

Each surgeon has his or her preferred approach to the problem you present with. Placing gel implants on top of the muscle is certainly one choice but submuscular placement has a decreased risk of breast hardness. I cannot say more without examining you

Doctor's Website

Richard Linderman, MD

Indianapolis Plastic Surgeon

ASAPS ASPS

Pocket position

I prefer to palce breast impalnts below the muscle which is really a dual plane approach. This will protect the upper pole and limit rippling there.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Is Above Muscle Breast Implant Placement the Best Approach?

Breast implants placed above the muscle are the best way to restore volume with "deflated" breasts. However tradeoffs include possible interference with mammograms, increased risk of capsular contractiure, and more prominent result.

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Over the muscle implants

In your situation, over the muscle or subglandular implantation is the best. You have no real breast droop, just loss of volume. I would recommend silicone implants as well over the muscle. It would give you a more natural look, feel, and shape.

Anthony Dardano, DO

Boca Raton Plastic Surgeon

ASAPS ASPS

Breast implant position.

Hi! Your surgeon is absolutely right. To correct mild sagging such as you have, the best thing to do is to put implants over the muscle. This is what we do in New York, and t works great.

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Breast implant placement

Most breast implants are inserted under the pectoral muscle (subpectoral). The reason for this is a lower rate of capsular contracture (scar tissue), more natural appearance, and easier mammogram interpretation. This is not to imply that over or in front of the pectoral muscle is incorrect, however there are many more advantages with the subpectoral approach. In your particular case, the recommendation of placing the implant in front of the muscle is likely to avoid any need for a breast... more

William Bruno, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Placement of breast implants below or above the muscle

I believe you should almost always go below the muscle (partial submuscular or dual plane are the terms). These give better mammograms, look more natural, and probably have less capsular contractures. Above the muscle implants can look like a ball in sock and matronly. Not so pretty.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

Above vs below the muscle augmentation

By the image you posted, you have some laxity of your skin and some mild asymmetry as well. My personal preference would be to place your implants partially under the muscle with what is referred to as a dual plane release (relasing a bit more of the muscle). This would lend you a better upper and middle breast coverage but I would have to examine you to see if this is OK without some form of a lift. It depends as well on the size implant you chose too. I rarely perform above the muscle... more

Michael C. Edwards, MD

Las Vegas Plastic Surgeon

ASAPS ASPS

Above or below the muscle breast implant placement?

It is hard to answer by just looking at one photo, but it is important to understand there are 2 options: above or below the muscle. My preference is below the muscle, but what you probably need is an implant placed in a dual plane, which means the implant is partially under the muscle. The upper 2/3's is covered my muscle and the lower 1/3 is not. The choice between saline and silicone is personal, and you should be well informed of the pros and cons of both.

Albert Dabbah, MD

Boca Raton Plastic Surgeon

ASPS

Going Above the Muscle Has Some Advantages

Because you have some sagging, many surgeons may opt to place your implant above the muscle to allow more appropriate placement of the implant beneath your lower breast. The downsides are a slightly increased chance of capsular contracture and possibly a more visible implant edge or "break" between the chest wall and breast at the top. A gel implant will lessen that last issue, though. A board-certified plastic surgeon will be able to decide this upon examining you.... more

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John LoMonaco, MD

Houston Plastic Surgeon

ASPS

Breast implant placement is matter of opinion

Hello, Much of that which you will find in plastic surgery is a matter of opinion. Over the muscle silicone gel implants have a higher rate of encapsulation (getting hard) over the long term. Then again they ripple less and you are thin. Even "under the muscle" implants in your case will probably be only about half under the muscle. These things are topics to discuss in pre-op so you can decide what is best based upon your preferences. Little of this is "set in stone."... more