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Should I Go Over or Under the Muscle?

asked 1 year ago by Bolton in Bolton, ON
Latest answer by Kim-Chi Vu, MD
Question viewed 1,647 times
Tags: age 35-44, 5 ft 4 in to 5 ft 7 in, sagging, silicone implant, 450-499cc, B cup, moderate profile, placement

I am currently a 34 B. I breast-fed 2 children.I used to be a full C up before my kids. I am 36 years old, 5 "4" and have mild sagging,loss of volume to my breasts. My nipple is still above crease. I am in great shape except for my empty breasts. I want to be a D cup and am opting for 450cc gels, moderate profile. Cant decide on the placement.

25 answers to Should I Go Over or Under the Muscle?

+2

Over or under the muscle?

I have to agree 100% with Dr. Stephenson. Your breasts demonstrate pseudoptosis, or bottoming out of the glandular tissue. The nipples, I think are OK, but really need the side view to knwo for sure. If you go with under the muscle, but do not use a dual plane 2 or 3 (probably a 3 in your case) technique, the glandular tissue will fall off the front of the impalnt like a "snoopy dog" deformity. The dual plane technique allows the impalnt to better fill out the lower pole of the... more
Mark D. Epstein, MD

Stony Brook Plastic Surgeon
+2

Kind of Both

A couple of observations.  It appears that you may have some mild breast ptosis and the upper portion of the breasts are empty.  I would recommend a dual plane placement.  This means the upper portion of the implant is beneath the muscle which gives you fullness but makes the edges of the implant less visible. The lower portion of the implant is covered by the breast tissue only.  This allows the nipple to move upward somewhat to help correct your ptosis without... more
Earl Stephenson Jr., MD, DDS

Atlanta Plastic Surgeon
+2

I'd Recommend Under the Muscle

Among the advantages of placing your implants under the muscle, the slope in the upper part of your chest will look more natural, with softer transition over the edges of the implant and less chance for rippling. Careful re-draping of the muscle and breast around the implant in the lower part of your breast will produce a gratifying result with the size you are considering.
Paul C. Zwiebel, MD

Denver Plastic Surgeon
+2

Above or below the muscle

Your photo is very helpful in answering this question. You have lost breast volume which is most apparent in the upper pole of the breast. The breast has fallen because the skin has lost its' ability to retract. Volume replacement is needed to restore a youthful shape and position of the breast. More volume is needed in the upper pole than the lower pole. Placing an implant below the muscle adds another layer of your tissue to the upper pole of the breast in addition to the implant.... more
Robert W. Kessler, MD

Orange County Plastic Surgeon
+1

Placement of implant

When I discuss about placement of the implants; on top vs behind the muscle, I tell my patient it depends on the amount of breast tissue you begin with. If you have adequate amount of breast tissue for padding purposes, then you can have the implants placed on top of the muscle. If you do not, then placing the implant behind the muscle would be the better choice. In addition, I also look at other parameters, such as where is the upper breast border in reference to the nipple position... more
Kim-Chi Vu, MD

Portland Plastic Surgeon
+1

Breast augmentation submuscular or subglandular?

Thank you for the question. Generally implants should be placed in the partially submuscular position for the best results and avoidance of complications. Some general advice regarding breast implant sizing may be helpful. Much of the final “look” achieved after breast augmentation surgery depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the ... more
Tom J. Pousti, MD

San Diego Plastic Surgeon

www.poustiplasticsurgery.com

+1

Implant placement. Above or Under Muscle

Most plastic surgeons prefer to place the implant under the pectoralis major muscle. They tend to look more natural as there is more tissue on top of them. they usually have a decreased rate of capsular contracture. They typically have a decreased rate of sliding down the chest wall. Each patient is different. Each plastic surgeon is different. Best to see three board certified plastic surgeons. Bring photos of what you might like. Please have... more
Jeffrey Roth, MD

Las Vegas Plastic Surgeon
+1

Above or Below the Muscle for Breast Implants

The advantages of placing implants below the muscle are as follows: 1. More coverage and less implant show and rippling at the top of your breasts 2. Lower rate of capsular contracture or hardening of your breast implants over time. 3. Slower rate of thinning of your existing breast tissue since most of the weight or pressure of the breast implant is behind the muscle 4. Easier to obtain accurate mammograms For all these reasons, the majority of our... more
Ankit Desai, MD

Jacksonville Plastic Surgeon
+1

Over or under the muscle?

Breast implants can be placed either over or under the muscle with good results either way. For saline implants, whenever possible, I prefer to put them under the muscle. The reasons are that there is less chance, although not zero chance, of developing palpable rippling or wrinkling of the implants. Also, under the muscle, the implants are massaged each time you move your arms, which will help keep them softer. However, if your muscles are tight, it may not be easy... more
James Tang, MD

Houston Plastic Surgeon
+1

Over vs. Under the Muscle: an Easy Choice

Mother Nature put your breasts over the muscles, so why would the plastic surgeon place the implants under? Here's why: the results are more natural in appearance, the implants are less apparent to the touch, there is less tendency to form troublesome scar tissue and mammograms are easier to perform. However, it is sometimes necessary to place the implants over the muscles, especially where there is a great deal of sagging and the patient does not wish a breast lift.... more
Eric Pugash, MD

Vancouver Plastic Surgeon

www.vancouvercosmeticsurgery.ca

+1

Over or unders: In a "pinch"! Breast implant placement

It appears that the vast majority of surgeons tend to favor the submuscular placement due to concerns with mammographic imaging, lowered incidence of capsular contracture and improved upper pole contours in thin patients with small breasts and skin pinch of less than 2.0 cm.
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+1

Breast Implant Placement Choice: Above or Under the Muscle.

Breast Implants can be placed in three breast planes: above the muscle (subglandular), below the muscle fascia (subfascial), and below the muscle (subpectoral). There are indication and advantages for all three with the most common being the subpectoral plane which places the 2/3 of the implant under the chest muscle with the lower 1/3 under the glandular tissue. The advantages are a more natural upper breast shape and less implant scarring with the disadvantages being longer recovery... more
Andrew P. Trussler, MD

Dallas Plastic Surgeon
+1

Advantages of Breast Implants Placed Below Muscle

There are advantages to placing breast implants below the pectoralis muscle.  These include a "more normal" appearing and softer breast.  Rippling of the implants is less likely and less visible as well.  The primary disadvantage is more discomfort in the immediate post-op period.
John Whitt, MD

Louisville Plastic Surgeon
+1

Over or Under the Muscle

Without question, you should have your implants placed beneath the muscle.  The upper pole of the breast is the area with the least amount of breast tissue, and often the area where women want additional fullness.  Placing the implants above the muscle will result in increased visibility of the implant in the area where most people will see in a bikini or V neck type top.  You want the most amount of tissue above the implant to help camouflage the transition from the chest... more
Vincent P. Marin, MD

San Diego Plastic Surgeon

www.marinaesthetics.com

+1

Over, under, or in-beween: how to decide on breast implant placement

You are no doubt familiar with the benefits and drawbacks of each approach: under the muscle gives better coverage and more natural appearing contours on the upper portion and inner portion of the breast when there is a thin fat layer under the skin. This is something your plastic surgeon can assess more accurately than any of us looking at a picture, but it does appear that under would look better in your case. This is more important when you are going fairly large as you are planning... more
Richard Baxter, MD

Seattle Plastic Surgeon
+1

Implant position

I prefer to place the majority of implants under the muscle.  Of course this really means that the upper 2/3 or so are covered by muscle. This will provide extra coverage over the implants.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Breast implant placement: over or under the muscle

In general, and I think in your case as well, under the muscle will give you the best chance at an outstanding result, with less risk of noticing rippling, especially at your cleavage line.  There are certainly a few situations where placing the implant in front of the muscle, but in most patients, in particular those who are quite thin such as yourself, I would place the implant behind the muscle.
Shahram Salemy, MD

Seattle Plastic Surgeon
+1

I disagree with my colleagues.

I have been doing this over 30 years, your breast tissue is over the muscle - you need to replace it, Nice silicone implants over the muscle will be the best in my hands. No one puts the implant entirely under the muscle anyway, it is a " dual plane" where the top half is under and the bottom half above. If you are active and exercise, the upper muscle can deform the implant and make it look wierd. When all we had were saline implants that rippled, under worked well. Now with the... more
William B. Rosenblatt, MD

New York Plastic Surgeon
+1

Above or below the muscle breast augmentation

In general, under the muscle provides an added layer to minimize the "bubble" at the top.  I compare it to a quilt on a bed which hides the underlying irregularities of the sheets and mattress.  In thin women or those with little breast tissue, over the muscle may produce the "cantaloupe" look, which is not natural-looking. With proper nerve blocks and the use of a pain pump for 2-3 days post op, my patients have had improved pain tolerance post operatively. more
Ricardo Izquierdo, MD

Chicago Plastic Surgeon
+1

Over/ Under ; for breast implants.

Based on the pictures provided I would say under the muscle would be better, and in general that is where I prefer to place breast implants for augmentation. Regarding the size you have not provided measurements so it is difficult to tell if that implant size is reasonable.
Walter D. Gracia, MD

Arlington Plastic Surgeon
+1

Under the muscle for augmentation

Generally, this is the more preferable location.  The more tissue covering the implant, the less the chance of visible rippling or palpablility.  It also puts the implant in a slightly different plane for mammography.
David A. Lickstein, MD

Miami Plastic Surgeon
+1

Breast implants under vs. over 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
+1

I recommend under the muscle placement of breast implants

Thanks for the details and excellent photo.  In general, most patients should go with under the muscle placement.  Generally above the muscle placement is reserved for patients who exercise every day, such as weightlifters.  Below/ under the muscle is done for the majority of patient, since you will end up with a more natural feel and have less rippling and wrinkling. 
Roy Kim, MD

San Francisco Plastic Surgeon
+1

Under the muscle please

Under the muscle is better for almost all patients in my opinion, even those that are extreme exercisers.  Mammograms are better, there is less scar tissue and the tissue coverage is thicker making them look better. Whether you call it "submuscular", "partial submuscular" or "dual plane", it is all the same. 
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+1

Implants over or under the muscle?

Thank you for the photo and detailed description!  I would place your implants beneath the muscle.  You are thin, and I would want as much coverage over those implants as possible to reduce the risks of wrinkling and rippling.  You will also have a slightly lower risk of capsular contracture by placing the implants beneath the muscle.  In my opinion, there is just no good reason to place your implants above the muscle.  Please be sure to see only surgeons who are... more
Carmen Kavali, MD

Atlanta Plastic Surgeon

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