Any Difference Between Having Implants Under the Muscle and Having Over Muscle?

i am 5.4 and 117 lb, i ware a 34 A and i am looking for a gel 325 cc. i am nervous about all i don`t know and i want to look like a natural breasts and not like i got some lollypops. Thank you. Also any difference between textured and plain.

Doctor Answers 20

Any Difference Between Having Implants Under the Muscle and Having Over Muscle?

As slender as you are you definitely want the implants behind the pectoralis muscle. When you look at photos of slender women with implants in front of the muscle you can see the entire top curvature, as if they had grapefruit halves under their skin. The muscle does not cover the entire implant but obscures the top and inner margins, thus mimicing a natural looking young breast. The textured implants have no benefit and several drawbacks, most doctors use the smooth surfaced devices. And most slender patients are prefering the silicone because of the more natural feel.

Portland Plastic Surgeon
5.0 out of 5 stars 17 reviews

10201 SE Main
Portland, OR 97216

For natural appearing breast augmentation, avoid the muscle and avoid 'over the muscle' go cold-subfascial!

Your best choice fo a natural appearance will be subfascial placement which is neither under or over the muscle but in a unique plane between the fascial covering of the muscle and the muscle itself.  No other technique can come close to the natural appearance that cold-subfascial augmentation delivers.  I have attached a video that explains its benefits.  I hope this helps!


All the best,


Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 46 reviews

4500 Biscayne Boulevard
Miami , FL 33137

Saline implants better under the muscle--Gel implants no difference above or below.

Placement of the implant above or below the pectoralis muscle has no effect on capsular contracture.  Saline implants are more liable to have visible contour irregularities if placed above the muscle.  Silicone gel implants have no aesthetic difference above or below the muscle.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

365 East Paces Ferry Road, NE
Atlanta, GA 30305

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Implants above or below the muscle

I am a firm believer in placing implants partially under the muscle for better coverage and I think a decreased chance of capsular contracture. This will provide a more natural appearance for the average patient but this depends on your starting breast volume and the size implant you chose. There is no one size fits all approach so the best thing to do is to have a consultation or two with board-certified plastic surgeons to see what your most appropriate options are.

I hope this helps.

Dr. Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 18 reviews

8530 W Sunset Rd
Las Vegas, NV 89113

Implant placement choices

I prefer smooth implants, under the muscle.  This generates in my opinion a more natural look, less capsular contractures, better mammograms, and less implant palpability.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.5 out of 5 stars 58 reviews

1135 116th Ave. NE
Bellevue, WA 98004

Under the Muscle vs.Over Muscle

For thin women, there is a greater risk of rippling which can be reduced if you have submuscular placement. While there has been some studies that have indicated lower probability of capsular contracture with textured implants, smooth implants is generally my preference. Consult with 3 - 4 experienced and expert board certified plastic surgeons to review your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 26 reviews

1501 Forest Hill Boulevard
West Palm Beach, FL 33406

Over vs. Under muscle

Having the implants placed under the pectoral muscle may help you achieve the natural look you desire.  The muscle helps to camoflauge some of the nuances of the implants.  The lower outer portions of the implant are not usually covered by the muscle, but the upper portion is, which is the part more visible when wearing a bathing suit or certain style tops and dresses.

Mennen T. Gallas, MD
Katy Plastic Surgeon
5.0 out of 5 stars 14 reviews

21300 Provincial Boulevard
Katy, TX 77450

Under the muscle implants are best

Since you are thin and size 34 A, you have small breast volume.  I would definitely recommend silicone gel implants.  They are less likely to ripple, feel more natural and the implants should be placed behind the muscle to provide additional padding and long term support.  Implants can be placed through an incision around the nipple or inframammary to hide the incision in the shaodw of the breast.  In your case, I do not recommend implants in front of the muscle.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 177 reviews

14887 Southwest Freeway
Sugar Land, TX 77478

Implant positioning and texturing of implants.

The choice of implant placement - under or over the muscle - depends mostly on the ability to camouflage the implants. For women with minimal breast tissue (as is likely with a 34A cup), the usual recommendation is for placement under the muscle. This avoids the visibility of the implant in the upper portions of the breasts and provides a smooth transition from the upper chest to the breast. The choice of texturing vs. smooth implants depends on two factors:

1. Capsular contracture concerns - some studies show a slightly decreased risk of contracture with textured implants

2. Shaped vs. round implants - all shaped implants are textured to provide some adhesion between the implant and the capsule to minimize rotation of the device. Round implants may be either smooth or textured.


Hope this helps!

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 13 reviews

660 Glades Road
Boca Raton, FL 33431

Under the Muscle

Most women will benefit from placement of the implant under the muscle.  To be accurate, only part of the implant is placed under the muscle.  The lower portion of the implant is usually not covered by muscle so you can get more expansion of the lower breast but this also allows the lower implant to be felt more easily.  Placement under the muscle should also help with mammograms and reduce the risk of capsular contracture.  On the other hand, the recovery following submuscular placement is somewhat more uncomfortable and you will have more movement of your implants when you contract the muscle.  I have stopped using textured implants as the evidence that they reduce capsular contractures is debatable and they can result in more rippling and a less moveable, less natural feeling breast.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 53 reviews

16216 Baxter Road
St. Louis, MO 63017

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.