Should Breast Implants Be Placed Under or over the Muscle? Doctor Answers, Tips

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Breast Implants Under or Over the Muscle-Which is Best

Opinions certainly vary but among most Plastic Surgeons today the most common answer you will get is under the muscle. Benefits include: · More tissue covering the Breast Implant · Less risk of Visible folds or Ripples · Less risk of firmness or capsular contracture However Breast Implant under the... more

Brooke R. Seckel, MD
Boston Plastic Surgeon

www.drseckel.com

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Breast Implants Under the Muscle

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

Michael Law, MD
Raleigh-Durham Plastic Surgeon

michaellawmd.com

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Under the Muscle is Usually Better for Breast Implants

Under the muscle is best for: thin women women with little breast tissue to cover the implant women with little or no drooping of the breast softer, more natural draping of the implant concealing implant ripples less chance of developing capsule contracture Over the muscle is best for: faster recovery women with enough natural breast tissue to cover the implant women with drooping who want larger breasts without a breast li... more

Paul C. Zwiebel, MD
Denver Plastic Surgeon

www.pzwiebel.com

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Over or under muscle placement of breast implants

One of the primary choices in breast augmentation is whether to have the implants placed "under" or "over" the muscle (submuscular or subglandular). This muscle is the pectoralis major muscle which lies over the rib cage and underneath the breast. It is the chest muscle that is commonly developed in weight lifters. Traditionally, when the majority of implants were silicone, implants were most often placed underneath the breast gland and on top of the muscle. With the... more

Alexander G. Nein, MD
Nashville Plastic Surgeon

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This is why I prefer to place breast implants below the muscle...

For most of my patients, placing breast implants below the pectoralis muscle is preferable. Implants placed below the muscle will have the following benefits: 1) Reduced risk of capsular contracture 2) Reduced risk of infection 3) Reduced risk of implant exposure 4) More natural appearance; especially on the upper portion of the breast. It is important to realized that implants placed below the muscle, are mostly below the muscle...not completely below the muscle. In... more

Kevin Brenner, MD
Los Angeles Plastic Surgeon

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Breast Implant Placement - Over vs Under the Muscle

Best practices are to place the implant under the muscle, although there are rare cases where it is better to place the implant over the muscle. The reason why it is better to place the implant fully under the muscle or partially under the muscle is because it creates a more natural look and feel, reduces the risk of capsular contracture and allows for significantly more visibility during a mammogram. With saline implants, rippling can occur whether the implant is placed over or under... more

Tarick K. Smaili, MD
Beverly Hills Plastic Surgeon

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Above or below pectoralis muscle for breast implants - Submuscular implants

Breast augmentation should generally be made under the pectoralis muscle to decrease descent of the implant, capsular contracture, and palpability of the implant. There are only a few cases that necessitate subglandular breast implant placement.

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

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Under or over (the muscle): Which is better?

There are a few indications when breast implants are better suited to subglandular (on top of the muscle) placement: a) Women who have adequate breast tissue; b) women who have "constricted" or tubular breasts and do not want a breast lift; c) women who are professional body builders, where the lateralizing action of the pectoralis major muscle may prove to be a distraction. Apart from these circumstances, most PS recommend the dual plane (below the muscle) location because it... more

Lavinia Chong, MD
Orange County Plastic Surgeon

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Why put breast implants either under or over the muscle?

I always say the same thing to my patients: easier to get good mammograms, lower risk of capsular contracture, better camouflage of the upper edge of the implant by the muscle. So yes, all of the above, but don't forget that the implants are not covered by the muscle in the lower half of the breast. That's why you can still feel the rippling at the lower part of the breast if you have thin skin. And that is why a lot of women are choosing gel implants. Because even... more

Robert M. Lowen, MD
Bay Area Plastic Surgeon

www.enhanced-you.com

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Breast Implant Choices

When deciding on undergoing a breast implant procedure there are many choices to make. There is no correct answer to the choices, only selections that make the most sense to the patient and the plastic surgeon. You need to consider your anatomy, cost, recovery time, long term effect on the tissues and the experience of the surgeon. Here are your choices: Above or below the muscle saline or silicone incision choice (under the breast, under the nipple,... more

David Finkle, MD
Omaha Plastic Surgeon

www.bodybyfinkle.com

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Breast implants, over or under the muscle

I would recommend placement of breast implants in the subpectoral location (under the muscle). There are several reasons for this: 1. lower incidence of capsular contracture/scar tissue 2. easier to interpret mammograms 3. increased ability to breast feed 4. more natural appearance of the breast contour. The placement of a breast implant in the subglandular location (above the muscle) has an easier surgical recovery, other than that, there are no advantages to this position... more

William Bruno, MD
Beverly Hills Plastic Surgeon

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There are several considerations that determine what may look best for you, and in some women either placement is a good option.

This is a good question and a very common one that patients ask. There are several considerations that determine what may look best for you, and in some women either placement is a good option. Confusion about implant plane is one of the reasons our office staff decided to write a new eBook about breast augmentation called "A Girlfriend's Guide to Breast Augmentation". It is a free download and I am attaching a link for you. Here are the pros and cons of both placements.... more

David B. Reath, MD
Knoxville Plastic Surgeon

plasticsurgeryknoxville.com

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Submuscular implant placement

In general the benefits of submuscular implant placement outweigh the detractors. If I were to perform a breast augmentation on a friend or family member, I would use the submuscular plane. When in doubt, consult multiple plastic surgeons. Most gather information from studies and practice evidence based medicine. One of the most frequent complications of breast augmentation is capsular contracture. This sometimes requires a capsulectomy surgery, and is a... more

Jason R. Hess, MD
San Diego Plastic Surgeon

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I prefer placing implants below the muscle

In my mind, the pro's outweigh the cons: Cons: Flexing the pec muscle will make the breasts move (this is not something that shows up with normal activities) The muscle can make the implants drift down and to the side (displacement exercises prevent this) Pros: Adds more coverage to the implant, so less chance of visible or palpable ripples Breasts have a more natural shape and maintain it despite aging Mammograms are more effective when... more

Michael A. Bogdan, MD
Dallas Plastic Surgeon

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Implant placement

Depending on which implant you decide on, silicone vs saline, determines it's placement. It is safer to place a saline implant under the muscle as for silicone its okay to place above. Do some research and consult with a board certified plastic surgeon before you make your final decision.

Jaime Perez MD
Tampa Plastic Surgeon

www.jaimeperezmd.com

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Breast implants should be placed under the muscle when possible

Implants should always be placed under the muscle when possible. Implants placed under the muscle have a much lower risk of capsular contracture and are more natural looking.

Usha Rajagopal, MD
San Francisco Plastic Surgeon

www.sfcosmeticsurgery.com

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Over or under the muscle?

I prefer to place most implants under the pectoralis muscle for all the reasons your surgeon told you: less wrinkling and rippling, less capsular contracture, more natural shape. Placing implants above the muscle generally leads to more implant palpability and wrinkling and rippling.

Carmen Kavali, MD
Atlanta Plastic Surgeon

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Breast implant placement, under or above the muscle

There are two options in where to place a breast implant in breast augmentation, under or above the muscle. In general, under the muscle is the most commonly chosen location. 1. Under the muscle (submuscular) - This location hides the implant the best so there are not obvious implant edges and visibility. There is also less risk of capsular contracture of the implant when placed below the muscle. Generally, the implant is not completely under the muscle and is in a... more

Naveen Setty, MD
Plano Plastic Surgeon

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Rippling of implants is possible after breast augmentation.

Rippling of implants is possible after breast augmentation in either the submuscular or subglandular positions. Rippling is most common on the lower, outer aspect of the breasts and is much more common with saline than with silicone. In fact the first step to correcting rippling is usually replacing the saline implants with silicone. Usually that is all that is necessary. The majority of implants placed today are beneath the muscle for the exact reasons that you mentioned.... more

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon

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Subglandular vs. Submuscular Placement

Submuscularly placed breast implants will be placed partially below your pectoralis muscles. The upper part of the implant will be fully covered by the muscle, with the bottom third of the implant covered by breast tissue, fat and skin. The major advantages of this approach are twofold: provides additional coverage of the implant and may reduce chances of capsule formation around the implant. Subglandularly placed breast implants, on the other hand, are placed on top of... more

Joseph G. Bauer, MD
Alpharetta Plastic Surgeon

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Above or Under the Muscle - Breast Implant Placement

Breast implants can be placed in the subglandular position (i.e. over the muscle) or the submuscular position (i.e. under the muscle). Most patients undergo breast augmentation because they have very little breast tissue. For all of these patients, performing a breast augmentation under the muscle creates a more natural look, minimizes implant rippling and visibility, and reduces capsular contracture of breast implants. In fact, most patients have their implants place under the muscle. In... more

Ankit Desai, MD
Jacksonville Plastic Surgeon

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Breast implant and the muscle

Breast implants may be placed underneath the pectoralis muscle or on top of the muscle. Typically, they are placed underneath the muscle if you have small breasts to begin to help conceal the implant. Often times, when placed underneath the muscle, the lower third of the implant is actually underneath the lower breast tissue (because the muscle does not always allow for total coverage of the implant). If the implant is large, the skin is thinning, or a combination of the two, you can see... more

David Bogue, MD
Boca Raton Plastic Surgeon

www.drbogue.com

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Sub-muscular breast implant placement is likely to look more natural

I have written a lot on this topic on my website and blog... I agree that placement of the implant at least partially under the muscle is much more likely to give you a better form. Breast implants placed under the breast gland alone have less tissue to cover them, and a higher rate of capsular contracture which can cause worsening rippling problems. In my Santa Barbara plastic surgery practice, I utilize a dual plane operation that allows an excellent non-operated appearance resulting in a... more

Adam David Lowenstein, MD
Santa Barbara Plastic Surgeon

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Breast implants over or under the muscle?

Breast augmentation surgery is the most popular cosmetic surgery in America because it can provide a beautiful result in which women can change the shape and size of their breast in a consistent way. For best results, it's best to work with a board-certified plastic surgeon who has a great deal of experience in breast augmentation and breast lift surgery. In our practice, we review with the patients their options in breast augmentation procedures. One of the options is whether the... more

B. Pat Pazmino, MD
Miami Plastic Surgeon

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Location of breast implants

Breast implants are not solid, so there will be some looseness of the implant that is seen as rippling. The rippling is less likely with silicone gel implants, compared to saline implants. Thin patients with less breast tissue and fat over the implants will also be more likely to show rippling. Implants placed under the muscle will be less likely to show rippling. However, the implants are really mostly under the muscle, as the muscle courses diagonally across the... more

Randy J. Buckspan, MD
Austin Plastic Surgeon

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Placement of breast implants above or below the muscle? It depends.

There are reasons to put implants above or below the muscle. Listing the options is too lengthy for this format but the link below thoroughly discusses the rationale that a plastic surgeon would use in deciding with the patient. I will say that there is no absolute in the discussion although many of my patients are surprised when I discuss the options with them.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon

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Above or below the chest muscle

I think more plastic surgeons place implants below the muscle than above these days. It takes a little longer for the breast to soften up and shape up when the implants are under the muscle but I think the extra time is worth it in the long run. My personal reasons for placing implants under the muscle are: 1. the extra coverage provided by the muscle lessens the possibility of ripples/wrinkles (especially in saline implants) which may be felt or sometimes even seen... more

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon

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Breast Implant placement - over or under the muscle

In most cases, implants are placed beneath the pectoralis muscle for several reasons. First, the extra soft tissue of the muscle over the implant contributes to a more natural appearing result. Secondly, deforming scar tissue formation around the implant, known as capsular contracture, is less common when the implant is placed beneath the muscle. Lastly, mammography may be easier to perform and interpret if the muscle is in front of the implant. Even when the implants are placed below the... more

Stephen U. Harris, MD
Long Island Plastic Surgeon

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Breast Implant Placement: Over or Under the Muscle

I would agree with all of the points outlined by the surgeon you consulted with. However, if your breasts have some sag, you might have a pleasing improvement by going just under the breast tissue and not under the muscle. Again, this is something best discussed with your surgeon, who has the benefit of meeting with you in-person and determining what's best for your body type.

Deason Dunagan, MD
Huntsville Plastic Surgeon

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Breast implants above or below the muscle...

Implants placed above the muscle have more of a chance of capsular contracture and rippling. Capsular contracture can occur because the body forms a membrane of scar tissue around the implant. If the membrane tightens the implant will feel hard. Rippling can be more easily seen when the implant surface ripples are covered by only a thin layer of soft tissue. Implants above the muscle have less tissue cover, so they are more prone to showing rippling. Check out the video below a discussion of... more

Ricardo Rodriguez, MD
Baltimore Plastic Surgeon

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Breast implants

When discussing the options in breast augmentation there are options you need to make: 1. SIZE. 2. TYPE OF IMPLANT (SILICONE OR SALINE). Saline Implants almost always will be felt or ripples will be seen. 3. PLACEMENT OF IMPLANTS. That depends on how much breast tissue you have. Thin civer to the implant then you need to go under the muscle, if you have enough breast tissue to give good cover to the implant then you have either choice. 4. THE SHAPE. Natural or "stripper look" will... more

Samir Shureih, MD
Baltimore Plastic Surgeon

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Here's the over under on breast implant placement

There are advantages/disadvantages to each area of placement. In my practice, I determine if there is enough breast tissue to cover the implant at the upper half of the implant. If there is enough breast tissue then placement of the implant over the muscle can be considered. The fact of the matter is that most women who present for breast augmentation have very little breast tissue so that placement of the implant over the muscle will allow the implant to be easily seen. Placement under the... more

Earl Stephenson Jr., MD, DDS
Atlanta Plastic Surgeon

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Visible rippling with under the muscle breast implants

These comments are all true. Under the muscle, according to my information, is the most popular route and performed by the vast majority of surgeons (approxiamtely 80%). This does not necessarily prevent rippling and it is nearly impossible in patients with extremely thin boy habitus and minimal breast and fatty tissue. In these circumstances sue of a high profile silicone gel implant or a cohesive gel implant is likely your best option. see video

Otto Joseph Placik, MD
Chicago Plastic Surgeon

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Under the muscle breast implant placement is better

There are MANY reasons why UNDER the muscle is Better - ALL IMPLANTS RIPPLE - the more soft tissue the surgeon can put on top of the implant, the less visible and less palpable such ripples will be (even by being under the muscle, your friend did not have enough tissue to cover up the implants and hide these ripples) - Under the Muscle = LESS scarring (Capsular Contracture) around the Implant - Under the Muscle = Slows implant drooping (ptosis) - Under the Muscle = Allows much better... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

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Muscle camouflages the Breast Implants

In general, implants should be placed under the muscle unless there is good reason not to - ie. if you are trying to take up some extra skin or in a bodybuilder. Placing the implant under the muscle camouflages the contours of the implant and the action of the muscle helps prevent capsular contracture. Keep in mind that the muscle doesn't cover the entire implant so, even with the submuscular approach, the lower part of the implant is really in the subglangular position. I agree that if... more

Jeffrey Horowitz, MD
Baltimore Plastic Surgeon

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Under the muscle breast implant placement results in less rippling

Hello, Rippling can result when implants are covered by little tissue. Under the muscle provides some coverage but it is not complete. The bottom line is that your friend would have likely had more rippling with an "over the muscle" placement.

John P. Di Saia, MD
Orange Plastic Surgeon

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Breast Implants placed under the muscle

Yes, the standard of care is to place the breast implants under the pectoralis muscle. Since breast implant placement has moved from sub-glandular (above the muscle) to sub-muscular (under the muscle), capsular contracture has decreased and the results are more natural looking. Each case is different and a board certified plastic surgeon should do a thorough examination before giving you advice.

Tom J. Pousti, MD
San Diego Plastic Surgeon

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Breast Implants and Muscle Coverage

I do agree as do most plastic surgeons that there are benefits of going under the muscle. All the described benefits are true. As far as rippling going inferiorly, over time, saline implants placed under the muscle will have some ripple effects inferiorly and laterally, especially if the implant is one of significant size. Most plastic surgeons these days will play the implant under the muscle or partially under the muscle (dual-plane). I would be weary of a surgeon who wants to place the... more

Farbod Esmailian, MD
Orange County Plastic Surgeon

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Under the muscle implants

I prefer to palce most implants under the muscle. I think that it camouflages better. The rippling that your friend has in the lower pole would most likely have occurred in the upper pole as well if they were placed over the muscle. Rippling in the lower pole can be treated with Alloderm.

Steven Wallach, MD
Manhattan Plastic Surgeon

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Should Breast Implants Be Placed Under or over the Muscle?