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Over the Muscle Breast Implant Placement Best for Sagging from Nursing?

asked 3 years ago by beccatj in tx
Latest answer by Paul C. Zwiebel, MD
Question viewed 9,937 times
Tags: droopy, sagging, C cup, nursing, over muscle, placement

I had 2 more consultations for breast augmentation today, and now I'm even more confused. I'm a 36C (deflated C) and do have a small amount of sagging from nursing. One of the doctors I went to today said that he wanted to go under the muscle, and that I didn't need a lift. The other one (board certified plastic surgeon) said that he wanted to go over the muscle and use an HP implant because I have some drooping, but not enough for a lift.

What is the major difference between going over and under the muscle? Will going over really give me upper pole fullness? I had always heard that going under was best, but I was told that because I have a good amount of breast tissue, going under wouldn't look right, and going over would give me a bit of a lift as well. I liked both of the doctors today, and am so excited about getting a breast augmentation. I just have to figure out whether to go over or under. Please help!

23 answers to Over the Muscle Breast Implant Placement Best for Sagging from Nursing?

Not every patient benefits from one technique.

There are many options when considering breast augmentation...silicone, saline; smooth, textured; round, anatomical; moderate profile, high profile; on top of the muscle, completely under the muscle, or partially under the muscle; lift, no lift etc. Generally speaking, if a patient has a somewhat droopy or ptotic breast and would like to avoid additional scars for a breast lift, they will be better served by having their implants placed partially under the muscle (dual plane) or on top of the m more

Sanjay Grover MD
Orange County Plastic Surgeon

Over or Under the Muscle: Neither Lifts the Breat

Breast implants add volume and can inflate a deflated breast, but never lift a droopy breast. Your question is complicated enough that it could not possibly be adequately answered here. It is also (obviously) a topic about which experts disagree. Be sure you like the look of whichever solution is being offerred: ask for examples/before and after photos to help you decide.

Paul C. Zwiebel, MD
Denver Plastic Surgeon

www.pzwiebel.com

Let's clarify this please

IMPLANTS ADD VOLUME - THEY DON'T LIFT THE BREAST. It has been a common misconception that placing an implant above the muscle will give the patient a lift - it does not. Eventually, you will potentially end up with a "ball in sock" bottom heavy matronly look with an implant above the muscle. Mammograms are more impaired, capsular contracture rates are probably also higher above the muscle, the result looks more edgy in some patients and the implants are more easily palpable... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Options with regards to the muscle

While it would be difficult for someone to tell you whether you would be best suited to have implants placed over or under the muscle without seeing you, there are a few things to consider that may help you. Currently, more implants are being place under the muscle, than over the muscle if you look at breast augmentations across the board. And, because of this, many people have heard that it is better to go under the muscle. This is, in fact, true for many women. However, some women are... more

David B. Reath, MD
Knoxville Plastic Surgeon

plasticsurgeryknoxville.com

Either breast implant placement can work well

I hate to add to your confusion, but the truth is that there is more than one way to achieve a nice result from a breast augmentation. It really comes down to the judgement of the surgeon based on his experience, your anatomy, and your goals from the procedure. In general, I find that while most women will do very well with the implant placed underneath the muscle, if a woman has a small amount of breast droop or ptosis, the implant can be placed above the muscle to create a very natural... more

Shahram Salemy, MD
Seattle Plastic Surgeon

Too much confusion with breast implant placement

Hi there, There are a few things to know and understand that I think will really help you be more comfortable, however you proceed. First, I think that you should choose a surgeon based on their training and expertise with the procedure in question, and your impression of their compatibility with you. It is a relationship after all, and you need to like them and get along well. Any individual surgeon will know what works well for them, and the operation one prefers for dealing with your... more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Yes, things can get confusing!

There is no best or right way to do an augmentation. You just have to prioritize the things you want or don't want. In general, since sagging is usually caused by laxity or excess of skin, filling it out is often more effective with implants over the muscle because the implants lies closer to the skin. It is also where the breast tissue normally lies (i.e. over the muscle). Depending on the size and model however, since the implant is closer to the skin, you might start to "see"... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Placing the implant above the muscle may avoid a breast lift in a modestly droopy (ptotic) breast.

Both of your surgeons might be right. Women with modest droopiness can often times have this camouflaged with a breast augmentation (presuming they want to be bigger). In this case, implant placement above the muscle is aesthetically surperior. If, on the other hand, an implant is placed and a mastopexy (breast lift) is done concurrently, the implant should go behind the muscle. This has to do with blood supply to the breast and areola. Placing the implant... more

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon

Above or below the muscle

Going below the muscle (I am assuming as a dual plane) adds another soft tissue layer of coverage over the implant. This will help with palpability and rippling issues. Some studies suggest lower capsular contracture rates.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast Implant Placement Pros and cons

There are pros and cons for each approach: 1. Below the muscle (or dual plane): Better implant visualization on mammogram Better protection for the implant Better used in very thin patients with little breast tissue Better used in saline impants due to future rippling 2. Above the muscle: Better projection More natural result specialy with a gel implant

Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon

Over or under the muscle implant placement

In order to determine the best and safest possible options for your case, photos would have been more helpful. However, based on the imformation you provided, a breast augmentation with some type of lift may benefit you. Depending on the severity and complexity of the case, you may be able to pull off a benelli lift to give your breasts a limited lift, which involves a "donut" incision around the areola alone. This minimal lift, may improve the saggy look of yor breasts,... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Above or below the muscle

Most implants are placed under the muscle these days for many benefits - better shape in the upper part of the breast, less implant visibility specially in thin women, significantly decreased capsular contracture rate, improved mammogram results as compared to above the muscle placement. However, there are women that would benefit from above muscle placement. There is no one answer for everyone. It depends on your specific physical attributes - breast size, shape, skin tone, mobility of... more

Bahram Ghaderi, MD
Chicago Plastic Surgeon

Augmentation technique should match the individual patient

Beccatj, When considering augmentation the technique has to match your breast for the best result over time. Time considered is taking the long view, how your breast will appear and feel after say 15 years. The benefits of submuscular augmentation are: significantly reduced capsule contracture rates, or firmness in the breast proper. smoother shape in the upper portion of the breast, a hidden upper edge reducing the "implant look" better tissue coverage, especially in thin... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Over or under breast implant?

Beccatj, Placing the implants above the muscle will give more of a lift effect than going under the muscle. But, the implants can only be placed above the muscle if there is thick enough chest wall/breast tissue to hide the implants. Without the benefit of examening you it is difficult to say what your best option would be. However, it sounds like your board certified plastic surgeon has a better grasp on things. An implant placed under the muscle on even a slightly sagging breast... more

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

www.francisnyplasticsurgery.com

Both over and under breast implant positions have benefits.

Beccatj, As you know, breast implants can be placed under or over the muscle. Both of your surgeons are correct. Placing them over the muscle (under the breast tissue only) will allow the implant to "fill" up the the missing volume in your skin and may avoid the lift. However, long term, the skin may stretch from the weight of the implant an you may likely need a lift down the road. Placing the implants under the muscle gives an extra layer of support to the implant. If... more

David Shafer, MD
New York Plastic Surgeon

Over or under breast implants

When a question isn't answered in 48 hrs. it usually means that a simple answer ("over or under") does not exist. Information like: Height, Weight,Body build,reproductive history, Breast diameter, and your objectives as to size and acceptance of scarring will play into the decision.

Barry H. Dolich, MD
Bronx Plastic Surgeon

Subglandular breast implants can sometimes compensate for breast sagging

Beccatj, I am glad you consulted 2 surgeons-call them and express your concerns and ask to see pictures of their results with a breast like yours. Many surgeons prefer submuscular breast implantation because there is less chance of capsular contraction and more tissue will cover the implant. The latter is important for women who have very little breast tissue-which sounds unlike your situation. A mature, slightly sagging breast often looks better with an implant placed beneath the breast... more

Brooke R. Seckel, MD
Boston Plastic Surgeon

www.drseckel.com

Breast implants should be placed over the muscle to correct slight sagging

To beccatj, Hi! Several points: 1) Implants over the pectoral muscle will definitely correct sagging much better than under the muscle. Over the muscle, the implants can "re-inflate' the breast skin much better. In fact, implants under the muscle with sagging can create a deformity. 2) Implants alone (in any position) will only correct a little sagging. If you have a positive "pencil test" (put a pencil under your breast, and if it stays there, it is positive), you may... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Silicone gel filled implants under the breast would probably be best for you.

For years the use of Silicone gel implants was limited to reconstructive surgery. As a result it became evident that in most women the best place for silicone saline filled implants was under the pectoralis muscle to minimize ripples and folds of the implant being seen through the breast and skin. Now with the availability of silicone gel filled implants, I feel that the best augmentations are accomplished with peri areolar {around the colored portion of the nipple) incision, sub mammary... more

Carl W. "Rick" Lentz III, MD
Daytona Beach Plastic Surgeon

We can't help much, but your doctor's opinions sound reasonable

Beccatj, Your surgeons have the advantage of being able to examine you and know more about your goals and expectations, so I can't tell you to choose one of those or even other opinions. I can tell you there may be several acceptable ways to achieve an attractive breast augmentation. Different surgeons may recommend different methods. For most patients I recommend subpectoral saline implants through an inframammary or periareolar approach. The recent introduction of cohesive silicone gel... more

Sutton Graham II, MD
Greenville Plastic Surgeon

Over the muscle gives a more distinct upper pole fullness

Most plastic surgeons prefer under the muscle in almost all cases because it gives a bit more natural look, allows for a better mammogram and statistically has a lower rate of capsule contracture. However, in this case, I think the argument can be made to go above the muscle with a higher profile implant. It will fill out the empty skin and definitely give more fullness in the upper pole. Some would say that it gives a bit of a "done" look. However , some women, and men, like... more

Talmage J. Raine, MD
Chicago Plastic Surgeon

No single best answer for everyone

You could have 2 or 3 more consultations and get as many different opinions. In gneral, going under improves the contour along the upper portion of the breast and may help it to look more natural. Some believe that implants are less prone to capsular contracture under the muscle. Disadvantages are that the breast may distort when you are being physically active and the muscle flexes, and that the muscle may tend to push the implants too far apart or down. So, it is a matter of the surgeon's... more

Richard Baxter, MD
Seattle Plastic Surgeon

Ptosis and breast surgery

You pose an interesting dilemma that will have many different opinions - which means none is all right. Ptosis is the sagging of breast tissue. If the breasts sag but the nipple is above or at the level of the inframammary fold the it is type I and can be treated with implants alone. However, as a physician with great breast lift results, I often suggest lifts to patients in this group as well as implants to make the breasts look as good as possible. If the sag is below the IM fold then a... more