Which Breast Implant Placement is Least Likely to Cause Sagging?

Which of the following method is less likely to cause sagging of the breast implants, above the muscle or behind the muscle?

Doctor Answers 18

Proper surgical breast implant placement is most important to prevent sagging after breast implants

The truth is that the most common cause of sagging or "bottoming out" of breast implants is that the breast implant pocket has been placed too low. The inframammary crease is a natural landmark and should not be violated during breast implant surgery--if it is, the implant will migrate down.

This can happen with either a submuscular or subglandular breast implant placement.

So, most important for you is to find an experienced board certified plastic surgeon who does a lot of breast surgery-i recommend consulting two doctors.

Another important issue is the strength of your tissues and the amount of breast tissue that you have.

Patients with very little breast tissue and thin skin are more prone to stretchinmg of the skin with time, and in these patients I do recommend the submuscular placement.

Some doctors leave a wide opening at the bottom of the chest muscle through which the implant is placed beneath the muscle-in these cases the implant often sags or is displaced below the muscle-so the advantage of submuscular placement is lost.

Too large implants are more prone to sagging.

The key is finding the best plastic surgeon and specifically ask questions about the above.

A properly placed moderately sized subglandular or submuscular implant in a patient with normal amounts of breast tissue and thick healthy skin should not sag.

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Don’t consider sagging to decide Implant Placement.

Sagging in the future is not one of the things to consider when deciding whether to place the implant in front of or behind the muscle. By pushing the breast tissue out, gravity can act more and cause droop no matter where the implant is placed. The resultant look is just slightly different between the two placements. When the implant is placed below the muscle and the breast sags the implant is frequently more obvious since the implant stays up and the breast tissue slides over the implant, giving a “double bubble” appearance. Instead of considering something in the remote future, you are better selecting the placement on more immediate concerns. I personally prefer placement above the muscle for a number of reasons. First, the implant is half out from under the muscle anyway. Secondly, the recovery is much faster (24 hours). Thirdly, if you are at all athletic, the muscle is not disturbed and does not bounce the implant with use of the arm. Fourthly, there is some good evidence that there is less likelihood of implant leakage with the implant above the muscle. The main reasons given for putting the implant under the muscle is to prevent capsular contracture and “rippling.” Rippling is actually a natural phenomenon of the breast from Cooper’s ligaments that connect the skin to the deeper tissues. With at least 2 cm. of tissue superiorly, I have never had a problem with this. If one uses a textured implant above the muscle, the contracture rate is the same as placing a smooth implant below the muscle. Also, if you have any droop presently, it is much easier to correct when the implant is placed over the muscle. I hope this is helpful.

Sagging breasts after augmentation

There are ways to prevent bottoming out of breasts (see video) Placing the breast implants behind the muscle can help. But, the size of the implant and placement on the chest wall are also very important.   In my opinion, all breast implants should be placed behind the muscle.  and there are two compelling reasons behind my opinion. First, radiologists have let us know that they can best image breast issue mammographically when an implant is in a subpectoral compared to a submammary position. Another compelling reason is aesthetic. The pectoralis major muscle serves as an additional layer of soft tissue coverage for the upper pole of the implant, and it tends to flatten the upper pole of the implant somewhat creating a very smooth and natural appearing contour to the upper pole.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 48 reviews

"Under the muscle" placement


"Under the pectoral muscle" breast implant placement usually lends more support and retards breast sagging, as long as really large breast implants are not used.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast Sagging After Subglandular and Subpectoral Augmentation

I do believe that the two methods have different long term outcomes. With subglandular augmentation only the breast tissue is utilized to hold the implant in it's proper position. In subpectoral or submuscular augmentation the muscle helps hold the implant in place.

But the reality is that the larger the implant is the more it will thin the overlying breast tissue thus weakening the support mechanism. So larger implants placed under the gland only will result in sooner and greater sagging as compared to submuscular augmentation. Nowadays, most plastic surgeons place the breast implants under the muscle to prevent capsular contracture.

Large implants may lead to sagging

There are many changes that may occur to the breast tissue and skin over an extended period of time. It is the weight of the implant against the breast tissue that causes laxity. When the implant is placed either above or below the muscle gravity, time and weight still exact their toll. The key to having a lasting result is an implant that is appropriately matched to the quality of your skin. If your skin is thin or atrophic then it will sag if the implant selected is too large.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 11 reviews

Sagging with implants

I do not think it makes a difference which pocket you place implants in. Most submuscular implants are placed after the muscle is released along the lower border. Therefore the implants are really just subglandular in this position. A breast lift will help with sagging breasts but the pocket will not make a big difference.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast implant placement and sagging

The positioning of your breast implants - in front of or behind the muscle - has some bearing on the sagging or the stretching of your breast tissue over time. Typically having your implant behind the muscle will cause less tissue stretch. However, the important factor is the quality of your skin and breast tissue. If you have good skin tone and a smaller breast size, no matter where you place the implant you will have minimal sagging over time. If you have poor skin tone and a larger breast size, the implant will accelerate the sagging of your breasts which are now heavier due to the implant. Also, implant size is more of a factor than implant position. Having a larger implant size will cause more sagging. Discuss your concerns with your surgeon before making final decisions on your implant and positioning of your implant.

Breast implant placement location least likely to cause sagging

" Which breast implant placement is least likely to cause sagging?"

All other factors being the same - SUB PECTORAL.

Not to belabor the point or lapse into sarcasm or philosophical musings on the meaning of life and aging, CLEARLY unless we die early, we all age and our tissues weaken and obey gravity's irresistible song and droop. So - without doing anything your breast will thin and droop with age.

How can you help gravity pull your breasts down faster? Long list. Become pregnant a few times, gain and lose weight a few times, do not wear a bra much of the time, smoke, eat poorly, spent time in the sun and tanning booths, have large breast implants put in and fail to support them, among others.

While ALL breast augmentations compromise some of the cables anchoring the breasts to the chest wall (Cooper's ligaments), placing the implant over the muscle divides many more of them. The only thing left to keep your breasts up is your skin (which may or may not be beat up by tanning, smoking etc) and a good support bra which may or may not always be there.

In short - SUB MUSCULAR + wearing a bra.

Good Luck. I hope this was helpful.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 69 reviews


In my opinion, under the muscle gives the advantage of more support. The muscle acts like an internal bra. It also gives additional padding/protection, and a lower capsular contraction rate.

The down side is a more difficult/prolonged recovery, and it takes longer for the implants to look their best.


These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.