Should I Go Over or Under the Muscle?

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.

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age 35-44 sagging 5 ft 4 in to 5 ft 7 in 450-499cc silicone implant B cup moderate profile placement

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25 Doctor Answers | Asked by Bolton in Bolton, ON

Doctor Answers (25)
Community Comments (1)

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

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

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.

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

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

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

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

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

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

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