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Over the Muscle - the Best Choice?

asked 1 year ago by Schmeather in portland, OR
Latest answer by Francis (Frank) William Rieger, MD
Question viewed 1,939 times
Tags: female, 150-169 lbs, 5 ft 0 in to 5 ft 3 in, C cup, over muscle

I had a consult with a local PS and he was very persistent that over the muscle would be the best choice for me. I am fairly active and lifts weights regularly. I am 5"5 and 162 lbs. I am currently a small 34 C. My concerns are sagging over time and having nice cleavage with the most natural feel/look possible. I only want to go up to a small D. I am also interested in silicone.

25 answers to Over the Muscle - the Best Choice?

+3

VIDEO: No right or wrong answer: Make a list, weigh the advantages/disadvantages and then choose: Over versus under the muscle

Under the muscle is most popular but it has disadvantages: I am attaching a video of the animation deformity that occurs. There is a very crude rule that essentially states that if you can pinch less than an inch of tissue from the upper portion of the breast than you should strongly consider going under the muscle. Another aesthetic measure is that if you can see your ribs along the upper portion of your chest, then again, you should consider under the muscle. Why? Well if you... more
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+3

Implant positioning above and below the pectoralis muscle

This issue is a bit like, which is better: saline-filled or silicone gel-filled implants. The difference is that above or below the muscle positioning of breast implants requires surgical technique and using past experience to decide which approach, properly done, will get the "best" result.  Properly done today with dual-plane muscle release technique, subpectoral (below the muscle) positioning of implants is only in part of the upper half of the breast. The lower... more
Scott L. Replogle, MD

Denver Plastic Surgeon
+3

Putting breast implants above or below the muscle

Schmeather, Going below the muscle hides the implant better, going above the muscle allows the implant to descent more naturally into your breasts. Because of the shape of your breasts, I feel that going under the muscle would not be ideal unless you have a small breast lift at the same time.  Going under the muscle will keep the implant up high and thus you need to lift your natural breasts or you'll develop a 'double bubble' look where the implant is one bubble and... more
Martin Jugenburg, MD

Toronto Plastic Surgeon

www.torontosurgery.ca

+2

Breast implants for weightlifters

Generally there is always a preference to having implants under the muscle because it will reduce capsular contracture, offer better viewing for mammograms and MRI's of the breast shape,as well as to protect the implants from injury. Exceptions are made when the patient may be highly muscular and may see implant displacement with muscle flexion. I am not sure that you are in this category without examinig you. I would also suggest that you will need some type of lift to... more
Francis (Frank) William Rieger, MD

Tampa Plastic Surgeon

www.riegercosmeticsurgery.com

+2

Breast implant position

Thank you for the question and picture. I think you would be best served with sub muscular breast augmentation. This implant positioning will give you the best long-term aesthetic results and reduce the chances of complications such as significant rippling/comparability/ encapsulation and interference with mammography. Best wishes.
Tom J. Pousti, MD

San Diego Plastic Surgeon
+2

Breast Implants Under Muscle

Schmeather, It is difficult to give you an answer based on your posted picture. My opinion is that under the pectoralis muscle is the best location for breast implants. I believe this for several reasons. First and foremost, radiologist tell me that sub pectoral implants interfere less with their ability to interpret mammograms that implants placed over the muscle. That is enough of a reason form me. Additionally, as my colleagues have written to you, placing the implants under the... more
Bernard Shuster, MD

Hollywood Plastic Surgeon
+2

Under vs. Over the muscle

There are some advantages of going over the muscle, but in most cases I prefer under the muscle. First of all it offers more camouflage for the implants so rippling is less evident, especially with saline implants. Secondly, going under the muscle has less interference with the milk ducts should you want to breast feed in the future. Discuss with your plastic surgeon your desired results and get his opinion. It is always a good idea to ask to see pictures and bring some of your own so... more
Joseph G. Bauer, MD

Alpharetta Plastic Surgeon
+2

SubGlandular or SubMuscular Breast Augmentation.....?

As stated here, there are many different opinions as to the "Best" way to proceed. My opinion starts with safety. It is commonly agreed upon that mammograms are a more effective breast cancer screening tool if your implants are placed under the muscle. You appear to be a good candidate for Submuscular Augmentation alone, with no need for breast lift. There are some cases that subglandular placement would provide a better cosmetic appearance than submuscular augmentation would....unl more
Daniel P. Markmann, MD

Baltimore Plastic Surgeon

DiscoverTheBeauty.com

+2

Implants over or under or over the muscle?

About 90% of the breast implants I do are under the muscle.  In your case, however, I would consider over the muscle.  You have plenty of breast tissue to provide padding over the implant (assuming you go with gels).  You are a weight lifter and implants under the muscle may bother you in the way they look and feel when you lift.  You also have ptosis (sagging) and putting the implants under the muscle may result in a "double bubble" where the implants ride... more
Lisa L. Sowder, MD

Seattle Plastic Surgeon
+2

Under for long-term results

Placing the implants under the muscle is best for a multitude of reasons -- less interference on mammograms, better coverage over the implant, less visability, lower rate fo cpasular contracture, etc).  The only draw back may be that they are a bit more compressed and so they may not produce quite as much immediate cleavage (fixed with a bra!) and they will move when you flex your muscle (might notice that a little with weight lifting).  From your pic, you may need a lift... more
Robert S. Houser, DO

Columbus Plastic Surgeon
+2

Placement of Breast Implants

There is not a "right" answer that fits for all patients.  Breast implant placement depends on your anatomy, tissue thickness, and desired outcome.  In general, I prefer to place the implants under the muscle.  I feel that this produces the most natural look to the breast.  Placing the implant under the muscle also increases the amount of your own tissue between your skin and the implant, which make the implant less palpable.  Good luck with your... more
David Shafer, MD

New York Plastic Surgeon
+2

You can have a nice result with over or under the muscle

I prefer to place the implants under the muscle.  This will give you a more natural feel no matter how thin your breast skin is or becomes in the future.  If you are into fitness, it is likely that you will be thin over your chest.  As such, it is important to use the muscle to "hide" the implant.  Otherwise, you are prone to rippling.  If done properly and with proper implant selection, the result can look great.  It also looks like you would do... more
Parham Ganchi, MD

Wayne Plastic Surgeon
+2

Over the Muscle - the Best Choice?

You will hear many different opinions. The correct  answer  has to do with surgeons preference and patients physical exam. Your prospective  surgeon have a clear advantage over any body else who has not have the opportunity to exam you.  In my opinion, if you are a weight lifter ,and you  have a thick skin, (the upper, lateral and medial pinch test measures more than 2 cm). Breast augmentation over the muscle will work well  reducing the... more
Jaime Perez MD

Tampa Plastic Surgeon

www.jaimeperezmd.com

+2

Best implant plane depends on what your anatomy provides

Hi Schmeather:  thanks for your photo, which appears to show a lateral "lie" to the left breast and a wide internipple distance.  The latter finding often makes the creation of tight cleavage difficult, if a patient will not accept a "wide" implant, whose base diameter can be manipulated to "close the gap" between the breasts.  In my opinion, a small silicone gel implant placed on top of the chest muscle would be preferable to minimize the... more
Lavinia Chong, MD

Orange County Plastic Surgeon
+2

Over or under the muscle breast implants

I personally do not agree that your best bet is above the muscle.  I would advise below the muscle with a lift for the best result.  Long term, above the muscle implants, especially if they have any size to them, tend to drop down into the breast like a ball in sock and can look matronly.  Mammograms are also better below the muscle.  Your activity level shouldn't change this either for me.
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+2

Breast Implants over the muscle for active arm use

Because of your activities with significant arm use and mild droop, over the muscle implants are definitely the right choice. You will also need some form of mastopexy (lift).  
Robert T. Buchanan, MD

Highlands Plastic Surgeon
+2

Over the Muscle - the Best Choice

From your detailed posted history and greatly appreciated photo I would entertain the over the muscle approach. I would need a more detailed in person discussion with you to make sure you understand the risk/benefit ratios.
Darryl J. Blinski, MD

Miami Plastic Surgeon
+2

Good choice

I agree too that they should go over the muscle, but remeber, the bigger you go the more you will sag. Nothing prevents sagging.
William B. Rosenblatt, MD

New York Plastic Surgeon
+2

Breast implants over the muscle best to correct slight sagging.

Hi. Based on picture, your surgeon is absolutely right. Over the muscle best option for weight lifters also. With good surgery, you can get natural result.
George J. Beraka, MD

Manhattan Plastic Surgeon
+2

Lots of variables involved

I'd agree that the volume of breast tissue you have makes you a reasonable candidate for going on top of the muscle.  However, I do tend to stay below most of the time because of the smoother appearance and reduction in risk of contracture.  Your activity level does not change my opinion about choice of location. If you've been to a surgeon you trust, then I'd go with his or her recommendation. Good luck!
Brian K. Brzowski, MD

Salt Lake City Plastic Surgeon

www.brzowski.com

+2

Over the muscle

This is a good question. The fact that you are active, makes animation deformity from muscle contraction a potential issue for you as well as the fact that I believe submuscular implant placement can lead to implant malposition over time due to stretching of the capsule surrounding the implant. When the chest muscle contracts it pulls the implant up and out- decreasing your cleavage- I don't think this is a natural look at all! Based on what you describe- I would recommend... more
Sam M Sukkar, MD

Houston Plastic Surgeon
+2

Over vs under breast implants for athletic women: other options

Your question poses a classic and difficult dilemma for many women who are athletic. Implants are most often placed under the muscle for a more natural appearance and to provide better coverage, but using the traditional method they are subject to what are called "animation deformities" with muscle flexion. On the other hand, low body fat means coverage is needed all the more. There are 2 options that are worth considering that are designed to find a balance between these competing... more
Richard Baxter, MD

Seattle Plastic Surgeon
+2

Over the muscle vs. under the muscle

It would be nice to know your age and reproductive history and whether you nursed ,BUT working from your picture I would agree with your surgeon for the following reasons: 1. You have asymmetry (mild) of shape and volume. 2. Left breast is lateralized (pointing more to your arm) 3. Both breasts  are signifintly lower than  the origen of your pectoral muscle negating many of the ad -vantages of under the  muscle. 4. you already have " good coverage' of... more
Barry H. Dolich, MD

Bronx Plastic Surgeon
+2

Over or Under Muscle Augmentation

Although I perform almost all of my augmentations by placing the implants under the muscle, you do possess 2 traits that make over the muscle possible.  They are the fact that you are a weight lifter and that you have a good bit of breast tissue.  Regardless you will need to refrain from weight lifting for a few weeks.  You might also need a lift.
John Whitt, MD

Louisville Plastic Surgeon
+1

Over or under the muscle

You are going to get a lot of different opinions about over or undr the muscle. It becomes a personal choice after reviewing the pros and cons. I prefer in most cases under the muscle because it provides more soft tissue coverage in the superior pole.
Steven Wallach, MD

Manhattan Plastic Surgeon

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