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Under the Muscle Vs. Over the Muscle? What's Really the Best Decision?

asked 7 months ago by bulldogs10 in Asheboro, NC
Latest answer by Alan Weiss, MD
Question viewed 349 times
Tags: under muscle, over muscle, submuscular

I have been to two consults. One doc says under, another says behind. Should I get a third opinion?

18 answers to Under the Muscle Vs. Over the Muscle? What's Really the Best Decision?

Time for the opposite opinion

I have been doing this surgery for over 35 years. In the beginning all implants were placed above the muscle, then an article came out claiming that under was better - so we switched to that. Turns out it isn't. When we went to saline implants, they needed the added cover of muscles to hide the rippling, now that we are back to silicone, I put most of them under the breast ( over the muscle). Ask yourself, "Where is your breast tissue?" The answer is Over the Muscle not under... more

William B. Rosenblatt, MD
New York Plastic Surgeon

Establish what is best for you

There is simply not one best way to perform breast augmentation for all patients. For some individuals such as extremely thin individuals with very thin tissues and little breast tissue, under the muscle is clearly the best approach to provide better padding for the implant and decrease visible rippling, particularly towards the midline and upper part of the breast. This is particularly the case with saline implants, but even gel implants ripple some, and will definitely be palpable in very... more

Jeffrey Hartog, MD
Orlando Plastic Surgeon

Breast Implants, Under or Over the Muscle...

When you have made the decision to have Breast Augmentation it can be difficult to know who to trust to obtain the best results. Typically the implants are placed under the muscle to reduce the chance of rippling due to lack of breast tissue. Some surgeons may recommend placing the implant above the muscle if the patient works out a lot or does heavy lifting daily. In addition, it may be placed above the muscle if the skin has some laxacity in it. I would speak... more

Andrew Miller, MD
Edison Facial Plastic Surgeon

Breast Implant and placement above or below the muscle

There are a variety of opinions as to whether a breast implant is best placed above or below the pectoralis major muscle. After 25 years of practice and having placed several thousand breast implants, I do not believe there is necessarily a right or wrong answer to this question. Each implant placement position has its potential advantages (BELOW THE MUSCLE - lower contraction rate problems, easier to read mammograms, may hide the... more

Vincent D. Lepore, MD
San Jose Plastic Surgeon

www.vincentleporemd.com

Under the Muscle Vs. Over the Muscle? Best Decision?Answer:

The thought keeps changing and will probably continue to do so! My colleagues in Brazil all go over the muscle but use the newer gel implants which are shaped and textured. So what it really seems to come down to is what result you are looking for and how much breast tissue you have to begin with. In lean women, under hides the implant better. And although I agree that in nature your breast sits on top of your muscle, the under muscle space seems a great location to have an implant placed. more

John J. Corey, MD
Phoenix Plastic Surgeon

Breast Implant Placement Over the muscle vs. behind the mucle

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

Over Or Under Muscle?

Although I placed all breast implants over the muscle 25 years ago when I first started my practice, it is extremely rare for me to do so at this time. Implants placed under the muscle tend to be softer and more naturally appearing and feeling, especially if they are silicone. The main downside is more discomfort during the first few days post-op.

John Whitt, MD
Louisville Plastic Surgeon

Best to place implants over or under the muscle?

Placement depends on the implants you select (size and composition), how lean your body is, how much breast glandular tissue you're starting with, how active you are with your upper body, and your personal preferences. Because every woman is different, for many, subglandular is best. For others, submuscular is best. Either choice produces acceptable results when the procedure is well executed.

Steve Laverson, MD
San Diego Plastic Surgeon

feelbeautiful.com

Under v. over the muscle

Most of my patients have implants inserted under the muscle. This avoids rippling in patients wtih thin skin, better pads the implant, makes mammography simpler and has a lower incidence of capsular contracture. The patient who opts for implants over the muscle is generally someone who wants implants badly but is unwilling to undergo the longer recuperation or is extremely fearful of postoperative pain. Ultimately, the patient, not the doctor, must own the decision and the consequences. ... more

Robert L. Kraft, MD
New York Plastic Surgeon

Most patients will have implants under the muscle

The vast majority of patients will have their breast implants placed under the pectoral muscle (subpectoral). There are many advantages for this: easier to read mammograms, more natural appearance, easier to breast feed and lower risk of capsular contracture(scar tissue). There are not many good reasons to place a breast implant in the subglandular (above the muscle) location other than the faster recovery. A board certified plastic surgeon can evaluate your specific anatomy and determine... more

William Bruno, MD
Beverly Hills Plastic Surgeon

Above or below the muscle

Having read most of the posted answers, I would agree that saline implants for the most part are better placed below the muscle in most patients. Gel implants may fair well above the muscle, but follow up for gel implants can be costly and time consuming. I am a bit surprised that no one has touched on this subject.

Alan Weiss, MD
Baltimore Plastic Surgeon

Under or over the muscle

There are many advantages to sub muscular implants. You will have less rippling and lower rate of capsular contracture. The overall look tends to be better in the long term appearance with going under the muscle especially if saline implants are used. You will also have a better image for the doctors to read during a mammogram if the implants are placed under the muscle.

Christine Rodgers, MD
Denver Plastic Surgeon

Breast implants and your pectoralis muscle.

The decision to place implants under or over the muscle depends on both anatomy and goals from surgery. In general, thinner women with little breast tissue will benefit from the improved soft tissue coverage of an implant under the muscle. However, other women will choose to have a more visible implant to avoid the distortion that can occur from submuscular implants when the pectoralis muscle flexes. A thorough discussion of your goals combined with a detailed examination is the key. You... more

David Bogue, MD
Boca Raton Plastic Surgeon

www.drbogue.com

Breast Implants Above or Below the Muscle

It may be better to ask each surgeon why they recommend above or below the muscle. For most patients, both options are OK, but for some patients one may be more appropriate.

Karol A. Gutowski, MD
Chicago Plastic Surgeon

Pocket placment for breast implants

There are positives and negatives to each pocket choice for breast implants. Under the muscle which is usually a dual plane( partial under muscle) gives more soft tissue coverage in the upper pole and helps camouflage against rippling. However, there may be animation deformities.

Steven Wallach, MD
Manhattan Plastic Surgeon

Above-vs. below muscle

98% of my patients have implants placed beneath the muscle for added stability, a more natural look, better coverage and lower rate of rippling. The few instances I have placed an implant above the muscle was with the complete understanding of a patient's lifestyle and desire-(mainly bodybuilders), someone who was looking for less recovery time and could not avoid adjusting their fitness regimen. I think you should get several opinions before making an educated decision about... more

Edward J. Bednar, MD
Charlotte Plastic Surgeon

www.drbednar.com

Under Muscle Generally Better

Submuscular implants have several advantages including: 1. Lower rate of capsular contracture. 2.. Less rippling. 3. Better mammography 4. More coverage of the implant. 5. Less disruption of blood supply to the breast. As a rule, I recommend submuscular implants (although exceptions do exist).

Brian Klink, MD
Sacramento Plastic Surgeon

www.solanoplasticsurgery.com

Breast Implants Under Or Over Muscle?

Thank you for the question. In my opinion, there are numerous advantages of sub muscular (dual plane) breast augmentation. This implant positioning will give you the best long-term aesthetic results and reduce the chances of complications such as significant rippling/comparability/ encapsulation and interference with mammography. Best wishes.