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Slightly Droopy Breasts - Implants over or Under the Muscle?

asked 10 months ago by judybee in Boston, MA
Latest answer by Remus Repta, MD
Question viewed 588 times
Tags: over muscle, submuscular

One surgeon recommended OVER the muscle 270 cc silicone implants to improve the appearance of my moderately droopy breasts. He felt going UNDER the muscle would be risky since the implants could sit higher on my chest than my actual breast tissue. I do a lot of weight lifting, so that might have figured into his decision that going over the muscle was the better choice. I’m 5'3", 128 lbs., muscular. What are your thoughts? Thanks in advance!

UPDATE: added my own photos after the before/after

20 answers to Slightly Droopy Breasts - Implants over or Under the Muscle?

Breast augmentation for sagging breasts

Hello and thank you for the question. In order to give you a more accurate assessment, it would be advantageous to see photographs of your breasts. Depending on the severity of your breast ptosis or sagging, you have several surgical options available to you. A breast augmentation with a subglandular implant placement, or implants placed above the muscle may provide a greater element of "lift" as compared to a sub-muscular or dual-plane approach, however the difference in... more

Glenn Vallecillos, MD
Beverly Hills Plastic Surgeon

www.BeverlyHillsCosmeticSurgeon.com

Submuscular implants are usually better than subglandular.

Subglandular implants have several potential disadvantages compared to submuscular: possible higher capsular contracture rate over the muscle; more risk of visible rippling; more visible implant borders; lower implant position/less upper pole fullness; perhaps less longevity of the result due to less soft tissue support. Some surgeons do prefer to place the implant over the muscle when there is mild to moderate droop, but for the above reasons, I think... more

Steven Goldman, MD
Cleveland Plastic Surgeon

www.drgoldman.com

Submuscular implants can help with moderately droopy breasts

A small amount of breast ptosis can be corrected with submuscular implant placement as long as a dual-plane technique is used. "Dual-plane" refers to differential release between the breast gland and the chest muscle which allows the breast implant to drop farther into the breast thereby stretching the lower pole and filling out the extra skin. This creates the illusion of a breast lift since the nipple sits higher on the breast mound but it doesn't create a... more

Jason E. Leedy, MD
Cleveland Plastic Surgeon

Advice for breast augmentation

Hello, The first step is to decide what breast size you want to achieve with breast augmentation. Regardless of volume if you choose saline it would be better to undergo under the muscle, and if you choose over the muscle you should go with silicone. In the ideal world any breast ptosis would be addressed with some type of breast lift as a breast augmentation is primarily designed to improve volume. If the amount of ptosis is very mild then a silicone implant of a certain size and... more

Remus Repta, MD
Phoenix Plastic Surgeon

www.aaaplasticsurgery.com

Implant position

The choice is yours but there is +'s and -'s for each location.. There may be flexion deformities under the muscle however, if you do not have a lot of soft tissue coverage, it gives more coverage int he superior pole. Under the gland may limit the coverage. As for strength, there probably is no effect on weight lifting ability once you have healed.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast Augmentation and Droopy Breasts

When deciding on the position of the implant either under or over the muscle it is very important to consider how much 'sag' your breasts have and whether or not you are going to do a lift. I usually place my implants under the muscle, however, in a patient who has mild breast 'sag' but does NOT want a breast lift as well, I place the implant over the muscle as your surgeon has recommended for you. This helps to prevent a 'Snoopy Dog' defromity in which... more

Louis DeLuca, MD
Palm Beach Plastic Surgeon

www.drlouisdeluca.com

Over the muscle vs under the muscle implants

Dear Judybee, I generally never recommend placing implants over the muscle for any reason. Implant placement over the muscle has more cons than pros in my opinion. Sub muscular placement is superior for many reasons: Less contractures, more than just skin envelope to hold implant in place, etc. If you are in need of a lift and would like larger breasts, then I would recommend a breast augmentation with a donut mastopexy (scar around the areola). If you just want a lift and no... more

Gary M. Horndeski, MD
Houston Plastic Surgeon

Droopy breasts and implants

It is important to understand that implants alone can not achieve a significant lifting of the breast. Your surgeon should guide you to perform the right operation for your breast. I understand the photos in this question are not yours. The result is an acceptable one for some individuals who are willing to sacrifice breast aesthetics to avoid scarring. The areola remains quite large and the nipple position is too low. This has nothing to do with implant position above or below the... more

Robert W. Kessler, MD
Orange County Plastic Surgeon

Over the muscle will probably give you a more natural appearance

Since you do have some drooping of your breasts, if you do not wish to have a breast lift done, then I would recommend breast implants on top of the muscle for a more natural look. For the best results, I would recommend a vertical ellipse mastopexy and submuscular implants.

James Tang, MD
Houston Plastic Surgeon

Over or Under the Muscle

Implants being placed over the muscle to "lift" the breast is not an effective way to treat sagging breasts. If you need to have your breasts lifted, then you need to have a lift. Lift come in variable shapes and sizes, but all come with a scar. The issue is not just adding a bigger implant which will eventually lead to more significant droop. The key is getting the best operation. and not setting yourself up for failure with a second procedure, more costs and more time out... more

Vincent P. Marin, MD
San Diego Plastic Surgeon

www.marinaesthetics.com

Droopy breast, over or under the muscle

There are advantages to submuscular augmentation, however the implant must fit within the skin envelop of the breast, hand in glove, to look and feel 'right'. If you wish only a small increase in volume, say 270cc, and the skin envelop is fuller, the implant may sit better and blend and flow better in a subglandular pocket. The implant under the muscle, if not large enough to 'flesh out' the breast may allow the breast itself to move over the implant in a kind of disconnect.... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Slightly Droopy Breasts - Implants over or Under the Muscle?

Best to post YOUR photos. I agree if a body builder I recommend overs. You may need a donut lift, but ? I don't know without photos of YOU.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Over/Under?

I have performed many surgeries on personal trainers, body builders, etc and, for the most part, once an implnat is in place there isn't much reason to work out the pect muscle vigorously. In your case, you needed some sort of a lift to get things looking better and over the muscle implants could have accomplished this. With implants under the muscle you are forced a bit more into the lift to give the ideal result.

Scott E. Newman, MD
New York Plastic Surgeon

www.psurgery.com

Droopy breasts are not solved by implants alone

As Dr. Aldea nicely stated, the presence of a breast implant either above or below the muscle does not lift the breast in terms of moving the nipple back up above the crease and tightening the lax lower pole skin to create a nice toned and youthful shape. Unfortunately, there are doctors who worry that telling a patient they will need a lift will make them go elsewhere because of the potential for scars and increased expense. They will propose a much larger implant and... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Breast Augmentation San Diego

If those are your before and afters included with the question, looks pretty good to me. Subglandular implant placement (on top of the pectoralis major muscle) is preferred for women who are very active with their upper body. Submuscular placement may cause visible animation (movement of the implants with contraction of the pectoralis muscle) and also progressive lateralization of the implants over time, especially if they are smooth surface devices. Going on top of the... more

Steve Laverson, MD
San Diego Plastic Surgeon

Over the muscle implants may be better

If you have slighlty drooping breasts and do not want a breast lift, then implants placed over the muscle may be better for you. Placing them under the muscles may place you at risk of developing a "double-bubble" deformity.

Matthew Schulman, MD
New York Plastic Surgeon

Implants under or over the muscle

I'm not sure about your question -who's photos are those? There is a little confusion about implants "below" the muscle. They don't have to be completely under the muscle. If they are put completely under in women with droopy breast than "yes" the implants will tend to look too high with a "snoopy dog" appearance. If the implants are put in only partially under the muscle, as in a dual plane position than they get the coverage of the muscle in the upper 2/3 but are just under the breast in... more

Ronald Schuster, MD
Baltimore Plastic Surgeon

Lifting of Sagging Breasts with Implants and Other Urban Legends

Regarding; "One surgeon recommended OVER the muscle 270 cc silicone implants to improve the appearance of my moderately droopy breasts. He felt going UNDER the muscle would be risky since the implants could sit higher on my chest than my actual breast tissue. I do a lot of weight lifting, so that might have figured into his decision that going over the muscle was the better choice. I’m 5'3", 128 lbs., muscular. What are your thoughts? " As we all know, all... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast implant surgery

Advice, without direct examination, in your case is not a good idea. Your physical exam is critical in determining the best treatment option. For example, you may or may not benefit from breast lifting along with breast augmentation. I would suggest consultation with well-experienced plastic surgeons. There are pros and cons to each type of operation that you should consider carefully.