Under or over the Muscle? (photo)

OK I have a few questions about these placements. I really want my breast to sag like normal breast, and I don't want them to be perky. I dont want to go over 300cc either. I was hopping to get it through the armpit incision and possibly over the muscle. Ive seen pictures and i think the look more natural over. I want the flatter look too(not such a high profile(not perfect).

Doctor Answers 10

Breast Implants over or under muscle-consult two board certified plastic surgeons

Thank you for your question.

The answer to your question is not simple.  You do have some sagging of the breast which is called ptosis, which is when the nipple is at or below the crease beneath her breasts.

Statements that there is no place for sub glandular breast augmentation or placing the implant of the breast are inaccurate.

If you place a sub muscular implant in a sagging breast the muscle holds the implant too high and can push the nipple down creating an appearance called a Snoopy Deformity. To avoid a snoopy deformity a breast lift in addition to a breast augmentation is required as bi planar breast augmentation is often insufficient to compensate for sagging.  For patients who have mild degrees of sag or ptosis who absolutely refuse to have a breast lift, a sub glandular breast augmentation beneath the breast gland can often produce a nice result.

I suggest that you see two board-certified plastic surgeons who are experienced at breast enhancement surgery and base your decision on what you learn during the 2 different consultations.


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Under vs over the muscle breast implants

I choose not to ever place implants over the muscle. Implants over the muscle have a much higher rate of complications (rippling, contracture, pain, excess skin stretching) Trust me, implants under the muscle will eventually give you the look you submitted. Most PS show breast augmentation photos that are only a couple of months after the procedure. FYI, over the muscle breast implants account for the majority of revisions in my practice. I hope this helps you,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 147 reviews

Under or Over the Muscle for Breast Augmentation?

There really is no place anymore for breast implants that go under the breast but not under the muscle.  This has been replaced with the "dual plane" approach, which is half-and-half as the name implies.

If your breast is relatively high in relation to the crease under your breast, then the traditional approach under your muscle is best.  The implant must be concealed in the upper half by the draping of the pectoral muscle or there will be an obvious step-off visible, especially after a couple of years as the skin stretches.  Also, the implant is held up at the bottom by the muscle, which keeps the implant from dropping because it holds it up as gravity tries to bring it down.

But if your breast has some ptosis, then the breast implant needs to be placed a little lower to match the height of the nipple height.  The implant therefore is placed a little lower than the lowest edge of the muscle.  Now the lower half of the implant is under the breast, and the upper half is under the muscle (dual-plane).  You still get the muscle draping in the upper half that is so important.

Gregory Diehl, MD, FACS
Long Island Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast augmentation -getting it right the first time

As you can see from the posted replies there is no one size fits all solution. I would be equally concerned that your areolas are enlarged and the left more so than the right. Also there is more breast tissue at and above the nipple level than below it i.e. the breast tissue is not evenly distributed around either nipple. Although you may be able to correct the tissue distribution via the armpits using an endoscope you can only correct the areola with a skin incision near the areola. If you just put in implants without any breast adjusting procedures it is highly likely that you will be unhappy with the result whether or not you put the implants under or over the muscle.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Under the muscle (a dual plane) will likley give you the best immediate and long term result

Thank you for the question and picture.  You appear to have thin breasts with minimal breast tissue.  You will likely have less breast tissue as you age and implants that have minimal coverage do not look natural.  By placing cohesive gel implants in a submuscular / dual plane position (covered by muscle for the top 1/2 of the implant and breast tissue in the lower 1/2 of the implant) you will get the natural appearance that you are seeking.  This will give you a very natural breast shape and avoid the appearance of the roundness and rippling that is often seen whan an implant is placed above the muscle in a thin breast.  In addition, the submuscular / dual plane implant position has a decreased risk of capsule formation.  The armpit incision is an option but is associated with some increased complications.  Talk to your PS about the benifits and risks associated with the different incisions and implant pockets.  Together you will be able to come up with a decision that gives you the result that you are seeking.



Scott Barr, MD
Sudbury Plastic Surgeon
4.5 out of 5 stars 17 reviews

So you want over the muscle breast implants

There is nothing wrong with a lower profile gel implant over the muscle, and in the late 70's they were the 'standard'. You can get a very nice result and you should not be discouraged. Why under the muscle you might ask? The switch was motivated by much less show through or thinning, lower capsular contracture rates, less ripple, softer upper edge after higher profile implants were introduced, etc. all good things though there is never one answer for all individuals. Avoid shaped implants unless you will stand all the time, and the higher infection rate under the arm is a false scare as well.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 33 reviews

Above or below the muscle placement of breast implants??

Thank you for the question. For women who want a more natural look to their breasts and have adequate tissue to cover the implant, above the muscle is a good choice, because naturally the breasts are above the muscle. Now with the availability of the shaped implants in the US you can have even more of a natural look to your breasts, with the lower part being fuller than the top. Best of luck!

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast augmentation implant placement

Dual plane breast augmentation provides benefits of being on top of the muscle and under the muscle at the same time.  The upper portion of the implant is placed under the muscle, which helps to conceal the implant in an area where there is frequently less natural breast tissue for coverage, while the lower portion of the implant is placed over the muscle, frequently helping to provide a more natural contour in that area.

You may also wish to consider that an inframammary incision, placed just above the fold, ends up being on the back of a breast that has a little natural ptosis ("sag"), and is usually not visible when the breast is viewed from the front.  There are advantages and disadvantages to each surgical approach (as well as each implant location), and I would recommend that you discuss them in detail with a board-certified plastic surgeon before making any decisions.

Good luck.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 19 reviews

Under or over the Muscle?

In my opinion implants placed under the muscle using a dual plane technique give the most natural contours. Remember the axillary incision is nice in that it is hidden but there is good research that shows it has a higher infection rate and a higher risk of capsular contracture. That does not mean you should not use that approach, but you need to weigh that information carefully.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 15 reviews

Over vs under the muscle

No location is perfect, each offers a degree of tradeoffs. As to wanting a "natural" sag, be careful what you wish for as implants on top of the muscle can cause a rock in a sock deformity. Get opinions from at least two experienced breast surgeons. Good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon
5.0 out of 5 stars 20 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.