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Is it Better to Place the Implant Under the Muscle or Under the Mammary Gland?

asked 8 months ago by ioana4783
Latest answer by Michael A. Jazayeri, MD
Question viewed 571 times
Tags: under muscle, over muscle, subglandular, submuscular

Hello, I want to enlarge my breasts but I don`t know where it is better to be the implants, under the muscle or under the mammary gland, and why? Please, please help me. Thanks,

22 answers to Is it Better to Place the Implant Under the Muscle or Under the Mammary Gland?

Mastopexy and augmentation

I think you will benifit a lot from breat lift( mastpexy) with/out augmentaion. You have a good volume from your breast tissue when its lifted up can give a very nice shaped breast, with skin resectin only and reshaping your breast. Still you have the option of augmentation if you wish for more volume after the lift. on that case both options for the pocket (submuscular/ subglandular) will give good results. You need to discuss all the pros and cons of both your surgeon, good luck. more

Fatema S. Alsubhi, MD, SSC-plast
UAE Plastic Surgeon

Above or below the pectoralis muscle

It is not possible to be certain from the photo but the first issue is whether a lift (mastopexy) is required before an implant can be considered. If the nipple is more than two centimeters below the level of the inframammary crease behind it then a proper mastopexy (actually moving the gland with it's nipple-areola attached up on the chest wall) is required before an implant can be properly positioned. The overwhelming consensus and experience is that breast implants need to... more

Scott L. Replogle, MD
Denver Plastic Surgeon

IMHO, It is ALWAYS in your best interests to place implants behind the chest muscle

Hi there- The only advantages (to the patient) to placing implants over the chest muscle are: it is a bit less painful, and (according to some) it is better for correcting mild drooping of the breasts.... there are advantages to the surgeon (shorter operation, more operations per given time, more $$)... First of all, please know that when performed by an experienced surgeon, sub-pectoral (under the muscle) breast augmentation causes only mild pain that lasts for a few days. With... more

Armando Soto, MD
Orlando Plastic Surgeon

Under the muscle

Implant placement under the muscle carries several advantages, it reduces the risk of rippling, reduce the risk of capsular contrature and mammogram is easier to interprit when the implants are under the muscle. For that, i agree with most of the comments made her. The issue of whether you need a lfit of not has to be addressed with your plastic surgeon. The physical examination and seeing before and after photos of patient wih similar situation is advisable. It is also advisable to... more

Moneer Jaibaji, MD
San Diego Plastic Surgeon

Better to Place the Implant Under the Muscle or Under the Mammary Gland?

Respectfully, your breasts lost some of their volume and have sagged. A breast augmentation will add volume but will not raise the breasts significantly. To do so would require a breast lift , Mastopexy. Since there is NO perfect breast implant and all of them will have a variable degree of rippling when stood on edge (in the natural breast on the chest position), we want to cover the breast implants with as much of your tissue as possible. this hides the rippling and is best dome when... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast implants above vs. below the muscle

Because implants do not blend in well with surrounding tissues at their edges the usual recommendation is to place the implants under the muscle for those who have very little body fat or breast tissue to start with. The goal is to maximize the amount of tissue between the edge of the implant & the outside world/eye. The muscle we refer to is the pectoralis major whose lower border only reaches to the nipple or above the nipple in women. Thus only somewhere between 30 & 60% of the... more

Aaron Stone, MD
Los Angeles Plastic Surgeon

Breast Implants Under the Muscle vs. Under the Breast Gland

There are many advatages to placing breast implants under the muslce. First of all, the implants appear more natural as the muscle provides for a natural slope at the upper pole. Also, there is a smaller chance of seeing the implant rippling when they are placed under the muscle. Lastly, there is a significantly decreased risk of a capsular contracture - which is when the implant capsule, which is normally soft and not apparent, becomes thick, contracted, and often painful... more

Gary D. Breslow, MD
Paramus Plastic Surgeon

Considering all of the facts, under the muscle is better.

The more surgeons that answer your question, the more opinions you will get and, unfortunately, the more confused you may be. My opinion is that breast implants are best under the muscle and in you need a lift, get a lift. Implants on top of the muscle are easier to see and feel, have a higher risk of capsular contracture and rippling, they tend to sag more over time, they get in the way more when getting a mammogram and they make it harder to get a lift in the future if that... more

James McMahan, MD
Columbus Plastic Surgeon

Over or under?

Innyour photo, your breasts look ptotic. Sometimes putting implants under the breast will give you enough of a lift, or you might need a mastopexy with implants. I believe that implants should go in the same plane as your breasts, that is over the muscle. Especially when you are ptotic, under the muscle is the wrong place to go.

William B. Rosenblatt, MD
New York Plastic Surgeon

Breast implant above or below the muscle

In looking at your photos it appears that your own breast tissue is lower than the edge of the muscle, and ideally the implant is placed with the nipple as its bulls-eye. Taking that into consideration, you would need to have it placed above the muscle, unless you had a breast lift performed at the same time as the breast augmentation.

Julio Garcia, MD
Las Vegas Plastic Surgeon

Breast implants are best under the muscle

Most would agree that the best place for implants is below the muscle so you have better mammograms, less scar, and less easily palpated implants. Your situation needs an additional consideration and exam because it looks like your nipples may not be too low but that you do have a substantial laxity and a skin excess in the lower pole which will potentially look better with a lift. Otherwise you would need a huge implant to gather up the skin and this might make you too big for... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Submuscular V.S. Subglandular placement of Breast Implant

In most cases we like to place your implant under the muscle. This gives more tissue coverage and a more natural look. Mammograms are also more sensitive and the risk of forming a capsular contracture is lower. Occasionally placement over the muscle is indicated to better control the shape of the breast and occasionally to prevent the need for a lift. Some professional bodybuilders also prefer the implant on top of the muscle. Thx, MW see video

Michael L. Workman, MD
Portland Plastic Surgeon

Breast augmentation surgery?

Thank you for the question and picture. I think you will have a great result with a breast augmentation, preferably in the sub muscular position. The main question I have is whether you will need breast lifting as well. This will be best determined by physical examination in person. Consultation with a well experienced board-certified plastic surgeon will be very helpful. Some general advice regarding breast implant surgery may also be helpful. Much of the final... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

www.poustiplasticsurgery.com

Is it Better to Place a Breast Implant Under the Muscle or Over the Muscle?

In my opinion, long term, it is better to place the implant under the muscle for several reasons. First, considering one out of seven female in the U.S. will develop breast cancer, it is much easier to perform mammography with an implant under the muscle. Secondly, if the implant is placed over the muscle, a textured implant is recommended to minimize the risk of capsular contracture (tightening of the capsule around the implant). A textured implant is more expensive, and... more

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon

Is it Better to Place the Implant Under the Muscle or Under the Mammary Gland?

Based upon your photos I recommend a larger submuscular implant like 450 cc and at least a donut lift. Best to see boarded PS in person

Darryl J. Blinski, MD
Miami Plastic Surgeon

Under vs over the muscle implant placement

It is always recommended that implants are placed under the muscle for several reasons. less chance of capsular contraction (very painful and distorting) more natural in the long run muscle acts as 'shelf' delaying implant from downward descent less chances of feeling implant I also noted that you are in need of a lift. Please do not be misguided into the false belief that a large enough implant will correct your saggy breasts. Implants do not lift... more

Gary M. Horndeski, MD
Houston Plastic Surgeon

Over or under the muscle

My personal choice is under the muscle. the result in my opinion looks more natural, the implants stay softer longer, the muscle makes mammograms easier to read in the 75 % of the implant covered by muscle. You will need an uplift, but that way the breast tissue will be centered over the implant.

Rick Rosen, MD
Norwalk Plastic Surgeon

Where to put implant in ptotic breast?

You have some degree of ptosis or droop to your breast and this is best addressed with an uplift, although this does involve quite a bit more scarring than an augmentation. If you were happy to accept the limitations of just having an augmentation, then in order to fill the loose skin, you would be best to have the implant under the gland, but there is a chance that the upper border of the implant may be seen or felt as the soft tissue covering is sometimes thin here when there is a... more

Jonathan J Staiano, MBBS
Birmingham Plastic Surgeon

Breast implants position

I usually before a dual plane ( under the muscle) so that the upper pole has more tisue coverage of the implant.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast implants need to go over the muscle to correct sagging.

Hi. 1) As you can see there is a difference of opinion. You have to individualize. Both over and under the muscle are good, but for different patients. 2) You have quite bit of sagging, and putting implants under the muscle will create a deformity, with the implants seating way above the breast tissue. If they are put under the muscle, then you will need a breast lift at the same time. This is not necessarily a bad option, but, in my opinion,... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast implants under muscle or over? Know your 4 options

Thre are really 4 variations on breast implant placement: Subglandular, subfascial, submuscular, and split submuscular. Subglandular is above the pectoral muscle but behind the breast tissue, and is typically done only when there is good soft tissue coverage. The subfascial plane (pronounced like "fashion") is also above the muscle but the tough membrane on the muscle surface (the fascia) is lifted up for better support of the implant. The fascia is thin so it doesn't add much... more

Richard Baxter, MD
Seattle Plastic Surgeon

Breast Implant Position

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