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Under or over the Muscle Saline Breast Implants for 32AA?

I'm 25. No kids, 5'5" and weigh 120 lbs. I work out regularly so have quite a bit of muscle and am also a runner. My current size is 32AA. I have picked a dr and am having my augmentation on the 17 of this month. I don't want porno boobs so I just went with 325cc of saline. He says I should go over the muscle. I've been reading on here that under and muscle better for small framed girls. I terribly afraid of this turning out bad. I don't want "ball in a sock, ripples or Capsular contracture! Help me decide!!!

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age 25-34 AA cup 5 ft 4 in to 5 ft 7 in 300-349cc saline implants 110-129 lbs placement

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20 Doctor Answers | Asked by lee25 in harrison,AR

Doctor Answers (20)
Community Comments (3)

Slender Women Have Better Results Under the Muscle

A slender woman needs more tissue coverage over breast implants, especially saline. I strongly recommend submuscular placement of your implants, especially saline implants of the size you are considering.

Don't go over the muscle with saline implants

Some of the worst results that come to me for correction are from over the muscle saline implants in thin women. The results look poor, the implants are edgy, and often they are overfilled and hard in order to minimize their wrinkly nature. Go submuscular all the time, especially with saline.

Above or below muscle breast augmentation

Implants can be placed either above or below the pectoralis major muscle, and each can have its advantages and disadvantages. If the breast skin is very loose a subglandular (above the muscle) implant may fill out the breast better. If one is very thin and wants a more subtle look a submuscular augmentation may be the better approach. Capsular contracture can occur in either case but the risk is slightly lower in implants placed beneath the muscle.

Under or over the muscle

Lee- Most of the time, I choose to go under the muscle because it provides more camouflage for rippling because there is more breast tissue on top of the implants. You may already know that saline implants are more prone to show rippling and because of your stature and current breast size, it does not sound like going over the muscle would hide any of that rippling. Talk to your doctor about the possibility of going under the muscle and ask him what the difference would be. more

For you, saline implants will do best under the muscle

For women such as yourself who are trim and don't have an abundance of tissue to hide implants, the best position is under the muscle. If your implants are placed on top of the muscle, you will have much greater risk of wrinkling or distinct palpability. A silicone implant would likely be acceptable on top of the muscle, but generally I think that even these do best over the long term in a submuscular position. If you ever need a secondary procedure such as a breast lift, the operation will... more

Breast Implants over or under muscle

For the majority of women, I prefer to palce implants under the muscle. More specifically in a biplanar poistion. This gives more superio coverage than just subglandular. In a thin small framed person, I feel that this is the best way.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Don't place your breast implants over the muscle

This is becoming a more common question. There are some advantages of placing the implant over the muscle, and in some cases is recommended. But not in yours. You are young, have little breast tissue, and going with saline implants. These are all reasons to place your implants under the muscle. I strongly recommend you get another opinion. Is your doctor a board certified plastic surgeon?

You may do better with silicone implants

If you do work out your pectoralis muscle and do not want to see implant moving with the pectoralis muscle contraction, consider silicone above the muscle. The placement of saline implant above the muscle will cause rippling and visible implant line later. Discuss your concerns with your plastic surgeon..

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Breast Implant placement

There are a lot of things to consider regarding the placement of the implant. Frame size is not an indication to place the implant over vs. under or the reverse. Frame size guides implant size that will be appropriate. Personally, I prefer under the muscle (smooth, round, inframammary incision) in order to minimize the problems you mentioned. To minimize the risk of ripples even more, silicone gel implants are the way to go. If you feel uncomfortable, you should seek another opinion. sek... more

Breast implants over the muscle better for body builders.

Hi! 1) I don't know exactly how much you exercise, or how overdeveloped your pectoral muscles are, but if you have a very muscular chest, over the muscle breast augmentation is safer. 2) You should not be making this decision! This is a medical decision. Get a plastic surgeon you trust to make the right decision.

Best options for implants in athletic women

There are general guidelines for selecting over vs. under, relating primarily to coverage of the implant. In women with low body fat and small breasts, this usually means going under the muscle. However, there are problems with under the muscle in athletic women, especially a tendency for the muscle to distort the breast with flexion. That is probably why your surgeon recommended over, though the trade-off is a less natural look. There are other options for athletic women such as the... more

Thin women need muscle coverage of the breast implants

Lee, you have been given a lot of good information and I would agree with the idea of putting the implants under the muscle. I would also suggest that you consider a silicone implant with your situation. Women that are so thin with very little breast tissue generally have more opportunity to feel the consistency of the implant. As you consider all of the pros and cons you will be able to make the best choice for yourself. Best Wishes, Dr. Peterson

Marcus L. Peterson, MD

4 reviews

Saint George Plastic Surgeon

How to choose over or under the muscle for breast implants

Hi Lee25 - With only a small amount of breast tissue, you may be able to see the outline of the implants if you go over the muscle. However, to go under the muscle the pectoralis major muscle is cut and this may bother you when you exercise. In fact, you may be able to see the implants "move" when you flex your chest muscles. So, if you don't mind being able to see the implants, then over the muscle would be the way to go. Some percentages for capsular contracture are 9% for... more

Under muscle recommended for saline implants

I'll add my vote for under the muscle. When it comes to saline implants the results are much more natural if the implant is as deep away from the surface of the skin as possible. By putting the implant under the muscle you will have a much more nautral slope of the upper portion of the breast and much less risk of visible rippling along the cleavage area.

UNDER the Muscle is The Way To Go

The MOST important goal that assures a good breast augmentation is getting the best and maximal coverage of the implant with your own soft tissues. Placing breast implants under the breast / over the muscle works only in women who ALREADY have enough breast tissue. Doing so in women such as yourself inevitably results is sub-standard results which are hard to fix (with breast thinning, rippling) and a higher likelihood of capsular contracture scarring (due the constant amount of bacteria... more

Breast implants placed under the muscle.

SEE VIDEO BELOW FOR GENERAL OVERVIEW. Even if you place the implants under the muscle it is not likely that your ENTIRE implant will be covered by muscle. IF you go under, you will achieve better draping of your implant with less likelihood of stripper boobs, and lower chance of "rock in the sock" deformity, decrease visibility of upper pole ripples, and diminished tendency for capsular contracture. However, it does not entirely eliminate the possibility for lower and outer... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Under or over the muscle breast implant placement

Unless there is a distinct advantage particular to that specific patient for putting the implants on top of the muscle they are best placed under the muscle. There are many advantages to under the muscle, less risk of infection, less chance of capsular contraction, less upper pole show, less visible and palpable rippling. Downside is, it hurts more during recovery and potentially more bleeding during the surgery and movement of the implant with contraction of the muscles. In body builders... more

Placement of Saline Implants

I definitely feel that a better result is achieved when saline implants are placed under the muscle in a woman with a small amount of breast tissue. Your concerns about an unnatural appearance and especially rippling are very valid. Some surgeons are not comfortable placing implants beneath the muscle. With your concerns, you might wish to entertain a second opinion.

Breast implant decisions

I think you have a few conflicting factors. In any case, if you are uncertain, you should re-consult with your surgeon and discuss all advantages and disadvantages. The fact that you are AA indicates that you have probably very little breast tissue meaning that most of your post-op breast will be be comprised of the implant you choose. This makes saline implants a bit more unnatural feeling and the chance of observing features of the implant like roundness and rippling are greater. Usually,... more

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

Over or under breast augmentation

Lee, You will obviously find differences of opinion about this topic between different plastic surgeons. I am personally a big believer in placing implants partially under the muscle for better upper and middle implants coverage (especially in the thin patient) and I believe it provides more support to the upper breast shape. This having been said, I do not have the benefit of examining you and reviewing your anatomy. I would discuss with your plastic surgeon why they recommend that approach... more

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Comments (3)

babiesatemyboobs 4 May 2013

If you are afraid of rippling, do not go saline! I am also small (-32AA before!), and did ALOT of research and found the best for woman like us are silicone implants placed UNDER the muscle. Since I can speak from experience now (over a week!), they are the best! Even my hubby says they look big, but natural. I only went with 300cc and I am fitting into some D and some DD bra's, so don[t go too big. I also work out and feel that they will be fine once I get back into it. Hope all goes well!! :)

babiesatemyboobs 29 Apr 2013

Hi!! I am also tiny and more muscular...I started with -32AA (haha) and I went under the muscle. I am 4 days out and they l

babiesatemyboobs 29 Apr 2013

Oops, darn submit button. Sorry. Anyways, they look natural! I only got 300cc gummy style silicone and all my girlfriend admit that thy look and feel real! I just bought a C cup bra and I fill it out fully. Go under forsure and try the silicone instead, they look and feel way more natural!! Have fun with them :)

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