Should Implants Be Placed Under or over the Muscle for a Slim Frame?

I've seen 2 different and very good plastic surgeons, both have said I should go with silicone, but one said I should go with under the muscle and the other said I need to go over.

I'm pretty slim and if I pinch my upper chest skin I have less than 2cm. Every thing I have read tells me under the muscle is best. I don't know what to do?

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10 Doctor Answers | Asked by ANNAF in California

Doctor Answers (10)
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Thin patient and implants

If you are very thin, then you are better off having as much soft tissue coverage as possible. The muscle adds another layer especially in the upper pole.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Under the muscle

If you have thin tissue coverage, then the best placement for the breast implant is under the chest muscle. It provides more coverage, better shape, better for mammograms and has been documented to have lower capsular contracture rate. The implants will move when you flex the chest muscle so patients who are body builders may have concerns about that but otherwise most patients who are thin will do better with under the muscle placement.

I generally prefer under the muscle

I generally prefer to place the implant under the muscle especially with a thin patient. There are many options in breast augmentation. Educate yourself about the different choices. The more soft over the implant the more natural the result. If you are thin and you place the implant above the muscle any degree of capsular contracture wiill give you a very rounded, implanted appearance. If your goal is a more natural result then below the muscle may be the best approach.... more

Under is recommended for most women

ANNAF: When I discuss this issue with patients, I recommend subpectoral (under the muscle) for women unless there is an unusual reason to do otherwise. Discuss with each of your surgeon choices why they advise the method they do. Subpectoral placement generally improves mammograms, lessens capsular contracture risks, and contours smoothly over the upper portion of the implant. Thinner patients benefit more from the latter consideration. Silicone gel filled implants have recently become... more

2 cm or less of "skin" is good reason for subpectoral (under muscle) approach

If there is thin skin and soft tissue, it is best to place implants in the submuscular plane. The more soft tissue between the implant and the outside world, the better the result. There will be less visibility of the implant edges, less chance of rippling, and a more aesthetic contour i the upper portion of the breast. If the nipple position is above or slightly below the fold of the breast this is the best approach.

Under the muscle in general...

In general, the thinner you are, the more we prefer to put implants under the muscle in order to give you a better "cushion" and better tissue on top of the implant. It is difficult to say that it is wrong to put the implant above the muscle. These are very individual decisions. I would say that most would recommend below the muscle for a slim individual with thin breast tissue. Good luck.

Under the muscle

You have been given some good advice from the previous answers. I would recommend that you go under the muscle. With a small pinch test, the right answer is under the muscle. Even if you had a thicker pinch test the long term issues favor an under muscle pocket. The silicone implant is always a good choice.

Marcus L. Peterson, MD

4 reviews

Saint George Plastic Surgeon

There is no best way to place breast implants

You have to decide what is important to you and what risk you are willing to assume. The reason why there are different opinions and techniques is that there are different advantages and disadvantages. Both can give acceptable results depending on what you want. Rolls Royces are no better or worse than Ferraris. If you want a fast car, get a Ferrari. If you want comfort, get a Rolls. But personally, I drive a Mercedes and Honda. You get the picture. Under the muscle technique is used... more

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

Under the muscle

Hard to say with out examining you but it sounds like you should go under the muscle. Better coverage of the implant, less chance of encapsulation most of us feel. If you are that thin then under the muscle will be more natural. Good luck!

Under the muscle for sure

The thinner you are, the more you need to go under the muscle to maximize tissue coverage over the implant. The mammograms are better, the capsular contracture rates are lower, and the implants aren't as palpable, and they look more natural long term.