Breast Augmentation: Q&A

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Is it better to have implant under muscle or over muscle?

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20 Doctor Answers | Asked by Zena45 in Enumclaw WA

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Above or below the muscle for breast implants

Obviously there is no one "right" place to put a breast implant and not even any agreement among surgeons as to the "best" place. Unlike many surgeons, I feel that in general for most women on top of the muscle gives a more natural appearance. After all, the breast tissue we are trying to increase is above the muscle and I feel an implant above the muscle behaves and moves more naturally than one below it. I also feel that there is a different look for implants placed... more

Implant better under or over the muslce

If you are a candidate for under the muscle, I feel that is a better choice as the chances of capsular contracture are less. A little longer to get to the final result versus above the muscle but I feel it is worth it.

Above or Under the Muscle

In the vast majority of cases, I would prefer to place breast implants underneath the muscle for the primary reason that there is a significant increase in capsular contracture or breast hardness with implants on top of the muscle. Submuscular coverage gives more soft tissue coverage of the implants and in many cases makes mammography easier. Yes there may be a bit more post operative pain but with early stretching this can be decreased and long term, I think patients do better.... more

Breast Implants - Above or Below the Muscle?

This may be a somewhat controversial statement, but in my opinion there currently is really only one acceptable position for breast implants in an elective cosmetic surgery patient: behind the pectoralis major muscle (sub-pectoral augmentation). There are a number of very compelling reasons to place implants behind the pec major, and the most compelling one of all is the fact that radiologists report that the mammographic imaging of breasts for the purpose of breast cancer screening tends to... more

Michael Law, MD

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Raleigh-Durham Plastic Surgeon

michaellawmd.com

Better To Place Implant Below Muscle In Most Women

It is almost always preferable to place implants below the pectoral muscles if one is seeking a naturally appearing and feeling breast. Silicone implants also provide these qualities more frequently than saline implants. There is a bit more discomfort with submuscular implants but it is usually worth it.

Breast Implants - Above or Below the Muscle?

There is no simple answer to this question and it definitely depends on the individual patient. In general, under the muscle is the more common pocket position in the United States. The benefits include better coverage of the implant at the top and in the cleavage area. Additionally, mammogram is less impaired and reports seem to suggest a lower amount of capsular contracture (hardening around the implant). The drawbacks are that the initial surgery is more painful,... more

Over the muscle or under depends on the patient and the implant

These are the general rules: Over the muscle is fine in patients with enough subcutaneous fat to hide the implants, and better than subpectoral if the breasts are sagging. Under the muscle MAY produce a softer result and is better in very thin patients or those preferring saline implants. There are other factors--family history of breast cancer, textured versus smooth, silicone versus saline. Find a experienced plastic surgeon whom you trust and talk it out. more

Implants - under or over the muscle?

I rarely go over the muscle. In my opinion, under the muscle results in a more natural look and feel, lower incidence of capsular contracture and less interference with mammograms. The downside is that there is more discomfort postoperatively and there can be distortion of the breast with contraction of the pectoralis muscle. This distortion is rarely an issue unless the patient does a lot of upper body stuff in a teeny, tiny bikini top. I do go over the... more

Submuscular Implant Placement Generally Preferred

With regards to breast implant placement internally, their is no single right answer. In general, though, most women who undergo this procedure would benefit from going underneath the muscle. It helps prevent capsular contracture around the implant, provides more soft tissue coverage over the device, and makes mammograms a little easier to read. I hope this helps.

Breast implants over vs. under the muscle

There is no single answer to your question. In some cases under the muscle is better and in others over the muscle is better. In older women with slight drooping who are not A or AA cup over the muscle might be better. In youger thinner smaller breasted women under the muscle is better. Also the greater the proportion of native breast tissue to implant volume the better an over the muscle implant will look, especially if the implant is smaller. The question for a specific patient/person... more

Breast implants placed behind the muscle preferred in most situations

In general and as indicated by the near consensus of the other plastic surgeon respondents, placing breast implants behind the muscle (submuscular) provides more advantages and is more prudent than their placement above the muscle (pre-pectoral or submammary) for most patients. Some of these advantages include greater soft tissue coverage resulting in a more natural appearance and feel; a lower risk of capsular contracture (firmness developing around the implants); better visualization of... more

Breast implants positioning

Although it is acceptable to place breast implants over or under the pectoralis major muscle, most of my plastic surgeon colleagues prefer under (technically half under). "Under" provides certain advantages such as - less visible, less palpable, less rippling, and some studies show less capsular contracture (hardening due to excessive scar tissue formation around the implants). Best of luck...RAS

There are pros and cons for over and under the muscle positioning for breast implants

The best place for a breast implant depends on what the patient needs. In general though, implants under the muscle are less palpable, may be less troublesome for mammography, may have a lower risk of capsular contracture than for implants placed above the muscle. On the other hand, submuscular placement may take longer for recovery since the muscle is lengthened. Also in very athletic patients or weight lifters, the action of the pectoralis muscle can make the implant... more

Breast Implants Under or Over Muscle- Advantages and Disadvantages

Generally, most patients choose under the muscle for several reasons- - more tissue covering the implant, which results ina more natural feel - less risk of rippling and wrinkling of the breast implant - less risk of nipple sensation changes - less risk of lactation problems - mammograms are a little easier However, over the muscle placement also has some advantages - if you lift alot of weight, or are trying to build... more

Implants over or under the muscle

Breast implants can be placed over or under the muscle. I will usually place the implants under the muscle when there is inadequate breast tissue present. If there is an adequate volume of breast tissue present, implants can then be placed over the muscle. The decision to place implants over or under the muscle is based on the physical examination of the patient.

Implants above or below the muscle

Breast implants can be placed either above or below the pectoralis muscle of the chest. The rationale for this is to add additional coverage of the implant in the area that is most visible and most lacking breast tissue. However there are several other benefits to this decision. First of all the implant will look more natural. It is easier to follow your breasts radiologically for breast cancer over time. And, some studies have show a slightly lower incidence of capsular... more

Going above or below tge muscle, which is bettter?

Breast implants can be placed above and below the muscle; both location are used. In my practice, and the majority of practices, I usually place the implants below the muscle because it leads to a more natural result, is associated with less capsule foramation( hardening), and makes rippling less noticeable. If a pateint has a fair amount of breast tissue I may insert the implants above the muscle. But the ultimate decision should be made with your surgeon having exmained you. more

Breast implants, under or over the muscle?

The way I decide where to place the implant is based on your anatomy; how much breast tissue you have, skin elasticity and skin envelope compliance, saline vs silicone gel implants and of course your wishes based on your anatomical limitations. In my practice, I place implants in a partial submuscular (dual plane) pocket in about 85% of my patients, This is to have better coverage of the implant superiorly and medially. If a woman has adequate breast tissue to cover the imp[lant, than I... more

Implants under or over the muscle

I agree that each situation is different, however I most often recommend under the muscle because I believe that your result will end up looking more natural and feeling more natural. There is also less risk for hardening of the implant and you will get better visualization of the breast tissue with mammograms. There a few unique situations in which going over makes more sense so you should certainly discuss your case with a board certified plastic surgeon.

Breast Implants - Above or Below the Muscle?

Hi Zena45 in Enumclaw WA, As always, there are no absolute or "correct" answers. Each situation is unique, and you'll need to talk to your own plastic surgeon to get a specific answer. However, most people recommend and are getting implants underneath the muscles at this time. I go over some of the reasons in my video (see below) but, in general, you're less likely to see and feel the edges of the implant when it's under the muscle, particularly at... more