Under the Muscle Vs. over the Muscle?

Thank you for your question. Although there are advantages to placement of breast implants beneath the chest muscle, as discussed by other physicians answering this question, depending on the shape of your breasts, under the muscle placement can not always the done alone.If after pregnancy your breasts have sagged, and the nipple and areola are below the inframammary crease, that is the fold underneath your breast, then placing breast implants under the chest muscle may result in the nipple areola being pushed further down and creating an unusual appearance called the "snoopy deformity."If breast ptosis or sagging breast is present a breast lift or dermal mastopexy must be performed first to restore the nipple areola to a proper location before breast implants can be placed beneath the chest muscle. Some surgeons do both of these operations at the same time although many prefer to do the breast augmentation first, allow the implant to settle and then do the breast lift as a second procedure 3-6 months later.In patients who do not want to have the scarring associated with a breast lift and if the breast ptosis is not too severe, some surgeons prefer to place the breast implant under the breast gland and over the muscle which allows the implant to settle or fall down into the breast and avoid the "snoopy deformity".These issues are discussed further in the link to the article below.Be sure to consult a plastic surgeons who are certified by the American Board of Plastic Surgery, experienced in cosmetic breast surgery and to have an excellent reputation in your community.

Unfortunately, you have not provided any photographs but describe yourself as a saggy B.  If the implant is placed in front of the muscle, the additional weight will stretch the saggy envelope even more and you will be dissatisfied.  There is a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Through the same incision, implants can be placed.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. 

 

Best Wishes,

 

Gary Horndeski, M.D.

It is impossible to tell without a picture but i like under muscle +- a lift. The muscle helps to hide the implant and prevent rippling. Over the muscle is not the wrong choice, just another opinion.