Submuscular or on Top of the Muscle - Which is Right for Me ?

I am 41yrsOld and have lost over 60pounds. I have about 5 to10lbs to go. I am 5ft 4inches tall and my breasts have become very saggy after having children and weight loss. One of my breasts is a little larger than the other. My bra size is a 36D and I want to be a full D or DD to make them look fuller. I am getting saline implants (450cc) and was wondering if I should go submuscular or on top of the muscle? Which will have a lasting affect with less to no reconstructing later?

Doctor Answers (9)

Implant placement in saggy breasts after major weight loss

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I would be very hesitant to place any sort of implant in the subglandular plain and have not done so in over a decade. With a submuscular implant, your surgeon is able to create a breast mound that will be stable over time, and then by performing the mastopexy he can properly place the breast tissue over the mound. Whether you can get by with a vertical mastopexy or it will require a traditional inverted T is dependent upon the amount of loose skin that has developed from your weight loss. Ideally, if you are a candidate for a vertical mastopexy, then an inferior skin and breast tissue excision will tighten the base and allow the breast to maintain the more youthful elevated position over time. Subglandular saline prosthesis particularly one that is large, will just continue to bottom out and become palpable and less attractive.


Albany Plastic Surgeon
5.0 out of 5 stars 109 reviews

SubMuscular vs SubGlandular.....???

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You will find various opinions about where breast implants are best positioned. I personally will not place implants on top of the muscle at all. I used to place them on top of the muscle (subglandular) but as more and more studies began to show the many benefits of placing them under the pectoralis muscle (submuscular) I switched to only doing them submuscularly. I have seen a significant reduction in problems and complications with the implants in this position and will only place them in the submuscular position.  In MY opinion, the most important benefits of under the muscle is less chance of missing breast cancer on mammogram's, lower incidence of capsular contracture, and less likely to cause breast drooping throughout the years. The many long term benefits of "under the muscle" far out weight the one benefit I see for placing the implants on top of the muscle (less pain during recovery)

Daniel P. Markmann, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 69 reviews

Submuscular or on Top of the Muscle

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Very hard without posting a photo to advise. I primarily place the implants under the muscle and a lift may be the better option. Best to see boarded surgeons in your area, like Jack Fisher or Pat Maxwell. From MIAMI Dr. darryl J. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

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Submuscular implants PLUS a breast lift

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Almost certainly, with your age and weight loss you will need a submuscular breast aug and a lift.  Without the lift you will look very poor and matronly if your nipples have drifted down from an elevated youthful position.  Implants above the muscle will NOT fix this without a lift.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

Submuscular placement of breast implants for better results.

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I have found that the submuscular location results in: 1)more tissue covering the implant for a more natural look 2) improved mammograms when compared to the subglandular implants and 3) decreased rate of capsular contracture.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
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When over the muscle breast implants might be right

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Breast implants after significant weight loss or in the case of a large droop or ptosis in the breast can be a tricky business. The problem is that we need a good match between the skin envelop of the breast and the implant chosen for the final cup size. For a great result the implant should fit within the breast hand-in-glove, and should feel as one. If the skin is generous, and the implant is under the muscle, the breast may move over the implant in a disconnect between the two. After weight loss a subglandular silicone gel with your mastopexy may give a more natural result.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Implant placement in saggy breasts after major weight loss

+1

You lost over 60 lbs and now have saggy, most likely "deflated" breasts. You state that your cup size is 36D and you would like to be a D-DD. Placing large saline implants in breasts that are saggy is just asking for trouble. I believe the operation you would benefit from the most would be a short scar or lollipop scar breast lift which would keep you at a D cup size. You would have fuller, perkier breasts without the implant issues which are guaranteed to happen if you chose the augmentation. If after your breast lift you still think you would like to be larger, then a small implant can be placed behind the breast which would be less harsh on your tissues. I discourage you to have 450cc implants placed, unless you like to have multiple breast surgeries in the coming years.

George Marosan, MD
Bellevue Plastic Surgeon
5.0 out of 5 stars 9 reviews

Implant position

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Placing implants above or below the muscle is a choice you make with your surgeon. I routinely place them under because I think themore soft tissue coverage the better.  It may decrease the risk of capsule formation as well.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Submuscular or on Top of the Muscle - Which is Right for Me ?

+1

Regarding: "Submuscular or on Top of the Muscle - Which is Right for Me ?
I am 41yrsOld and have lost over 60pounds. I have about 5 to10lbs to go. I am 5ft 4inches tall and my breasts have become very saggy after having children and weight loss. One of my breasts is a little larger than the other. My bra size is a 36D and I want to be a full D or DD to make them look fuller. I am getting saline implants (450cc) and was wondering if I should go submuscular or on top of the muscle? Which will have a lasting affect with less to no reconstructing later
?"

It SOUNDS like you already made up your mind regarding the operation and the implant type and volume. The location of the implant SHOULD have been part of that consideration. At this point arbitrarily saying one or the other would be somewhat capricious.

I would have approached the process in a different manner.

FIRST, you should have considered if you truly needed breast implants in the first place. It sounds as if you are in need of a good Breast Lift procedure with a minor reduction on one side. That being done would give you a much longer lasting set of perky, similar breasts without incurring the complications of a permanent implant (sagging, deflation,capsular contraction,thinning of breast tissue, potential sensory losses etc). You may even be able to get a little extra volume in the future with fat transfers to the already lifted breasts for a more natural result.

IF you insisted on going larger, I would prefer to place the implants UNDER the muscle, especially if you insisted on having saline implants which tend to ripple more than silicone filled implants. Would you be having a Breast Lift at the same time? If so would you want the larger side made smaller OR a larger implant placed in the smaller breast to reduce the asymmetry? Would the Breast lift be done at the same time as the Breast Augmentation OR would it be done later to allow for tissue and implant sagging which could be better corrected in the later operation?

As you can see, the situation is NOT as simple as WHERE does the implant go. You deserve a full consideration of your issue. Only if done in this way will you have a chance at a good result.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.