Which Breast Implant Placement Gives a More Natural Appearance? Doctor Answers, Tips

+12

Breast Implant Placement Important Considerations

While the issue of ‘over’ or ‘under’ the pectoralis major muscle receives a great deal of attention, even more important than implant position relative to this muscle is implant position vertically and horizontally on the chest wall. In many patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola, and in order to prevent the appearance of excessive upper... more

Michael Law, MD
Raleigh-Durham Plastic Surgeon

michaellawmd.com

+9

Implants placed beneath the breast tissue only tend to give the most NATURAL results!

Most women I see in consultation are looking for a NATURAL, not a "done" or fake result of breast augmentation. I see both professional women who work full-time and full-time Moms, from all over Northern California and also occasionally Canada (my original home!). Most are very physically fit, at their ideal weight, and are quite physically active, using the pectoralis major muscles all the time for activities of daily living. In fact, we ALL use these muscles... more

Karen M. Horton, MD
San Francisco Plastic Surgeon

www.drkarenhorton.com

+8

The natural looking breast implant

I strongly concur with Dr. Williams excellent and detailed response. I offer patient's a simple analogy to illustrate what we mean: Q: If you take a baseball and you cover it with a silksheet, what will it look like? A: Like a baseball, you will even see the stitching. Q: Now if you take that same baseball and cover it with a comforter what will you see? A: It depends on how thick the comforter is but generally you will see a softly shaped lump. So now the question is what do you have on... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

+5

In general, under the muscle gives a more natural result

We women are incredibly aware of our breast appearance-- maybe even more than men are. Breasts are sexual and sensual, a big part of what makes us women, and they can dictate our sense of attractiveness and desirability (for better or worse). Breast augmentation is one of the top three most popular plastic surgery procedures performed. So many women embrace this procedure because it carries little risk of complication. And because an implant can be inserted through a tiny incision in... more

Michelle Copeland, MD, DMD
New York Plastic Surgeon

+4

Your body is the key

In my San Francisco practice most of my patients have implants placed under the muscle. Creating a natural looking augmentation has many factors, all of which need to be addressed. Some of these include (in order of typical importance): Implant size Implant shape (high profile, moderate profile, low profile) Implant position (over, under the muscle) Implant material Incision placement Your plastic surgeon should assess many factors including: your desired outcome and size breast volume skin... more

Steven H. Williams, MD
San Francisco Plastic Surgeon

+3

Under the muscle almost always better

I am a big proponent of submuscular breast implants. They are less like to stretch out the breast and make it droop over time. They hide the implant and make it look more natural. They are less likely to interfere with breast exam and mammography, and they are less likely to get hard. Some surgeons recommend on top of the muscle implants for droopy breasts. It is true they will fill out a droopy breast better at first. However, shortly thereafter, they... more

Daryl K. Hoffman, MD
Los Gatos Plastic Surgeon

+3

Breast implants can look natural both under and over the muscle

Breast implants can look very natural in either position. There are several factors which influence whether or not the implants look natural: 1) How much tissue the patient has overlying the implant. I recommend that thin patients whose ribs are showing have the implant under the muscle. When the implant in under the muscle, the upper, inner half of the implant is covered by the muscle, not the whole implant. By placing the implant under the muscle, extra "padding" is provided... more

Tracy Pfeifer, MD
Manhattan Plastic Surgeon

drpfeifer.com

+3

Silicone implants

It was interesting to see the return of silicone implants in 2006 and how much better breast augmentation patients were looking. Gone were the torpedo, shelf look, and in was a more natural voluptuous result. The europeans have known for a long time that silicone implants have a more natural softer look.

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon

+3

In a word, under,

But Emzy nothing in breast surgery can be done in a word. In general, because under the muscle placement provides an extra layer of tissue over the implants they are less apparent as implants. It's like placing a comforter or blanket over a golf ball compared to placing a sheet over a golf ball, try it yourself. Although this also generally results in a more "natural" appearance, it is not for everyone and many patients look just as natural with implants above the muscle. A... more

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

www.francisnyplasticsurgery.com

+3

You are natural

When patients tell my they want to look natural, I tell them they are natural, they just don't like it. Once you put in an implant, you are unnatural. The question is how to make them not look unnatural. Remember also that looks are only part of the naturalness. Feel, texture, and movement are other factors. In general, an implant over the muscle will move more naturally because that is where the breast tissue lives but an implant that gets hard or is too big will look unnatural. Implants... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

+3

I prefer submuscular placement

As you can see, there are many opinions about the best placement of an implant. Certainly, the patient's body habitus plays a role, but really only if you are looking for a reason to go above the muscle. Remember, you can generally always go below the muscle in a first time augmentation patient. The only implant I would ever consider using above the muscle is gel because the salines are too wrinkly in that position, or are pumped up too full and hard to compensate for the ripples. But I... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

+2

Under the muscle is usually better for breast implant placement

Under the muscle is best for: thin women women with little breast tissue to cover the implant women with little or no drooping of the breast softer, more natural draping of the implant concealing implant ripples less chance of developing capsule contracture Over the muscle is best for: faster recovery women with enough natural breast tissue to cover the implant women with drooping who want larger breasts without a breast lift... more

Paul C. Zwiebel, MD
Denver Plastic Surgeon

www.pzwiebel.com

+2

In the long term breast implants placed under the muscle look better

Breast implants placed over the muscle look more natural at the begining, but in several months they start to sag, especially if they are large. On the other hand, breast implants placed under the muscle take about 3-4 months to settle, but then they look the best for a long time.

S. Sean Younai, MD
Beverly Hills Plastic Surgeon

+2

Placement of breast implants has to be individualized.

Hi. 1) In a thin patient with flat breasts, under the muscle is the way to do a breast augmentation. 2) If we are trying to correct slight sagging with breast implants, then over the muscle gives much better shape. 3) For occasional women, we use the dual plane approach, which is a combination of the two.

George J. Beraka, MD
Manhattan Plastic Surgeon

+2

Natural look to breast implants

I believe over the muscle gives a more natural appearance. But if you go too big, it still won't look good. Have an idea of what you are looking for, then try on sizers at the office with your plastic surgeon.

Jack Gelman, MD
Frankfort Plastic Surgeon

+2

Under the muscle is more natural, but size is a more important factor

The pec muscle looks like a triangle with borders along the sternum and clavicle. When an implant is under the muscle, the muscle helps maintain the slope to the upper portion of the breast. Natural breasts have more of a slope above, and curvature below the nipple. That being said, if you choose large implants (or too large), no matter where you place them, they will look fake. Reasonable sized implants can be make to look natural, and the muscle helps.

Michael A. Bogdan, MD
Dallas Plastic Surgeon

+2

Submuscular generally preferred

I recommend submuscular placement for almost every patient. The exceptions would be: Body builders Patient desiring removal and replacement of current subglandular implants for deflation or size change. (they have to be happy otherwise with the subglandular implants) Patients with fairly large breasts and excellent implant coverage (even then I prefer submuscular for appearance, feel, and decreased risks of contracture)

York Jay Yates, MD
Salt Lake City Plastic Surgeon

+2

Submuscular breast implants provide natural results

Breast implants are placed above or below the pectoralis major muscle of the chest. In the last two decades, a major shift occured in plastic surgery wherein submuscular implantation became the standard for cosmetic breast enhancement. The submuscular implant provides the following three benefits: Increased detection of breast tissue on mammography A more natural and soft curvature of the upper pole Decreased rates of capsular contracture as seen on clinical examination In most females of... more

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

+2

In general, a dual plane techique will give you a more natural result

Breast implants are placed either on top of the muscle, entirely below the muscle, or partially under the muscle in a dual plane approach. I generally prefer the dual plane, partial retropectoral approach because, in my hands, I am able to achieve a more natural, tear drop shape with this technique because it prevents the implant from being too high in positioin on the chest wall in a unnatural position. Best advice is to seek a board certified plastic surgeon at surgery.org to set up a... more

Sanjay Grover MD
Orange County Plastic Surgeon

+2

Under

Hello, "Unders" generally give you better long term results with both Silicone gel and Saline-filled implants. More coverage of the implants with healthy tissue makes a big difference over the long term. In reality this will amount to "partial unders" as on the underside of the breast there is no muscle for coverage. I tend to use as much of the pectoral muscle as is available as I believe that this provides the best long term result. Alot of this does depend upon your... more

John P. Di Saia, MD
Orange Plastic Surgeon

+2

It's all about you and your physical characteristics

You have asked a very important question--unfortunately, there is not one simple answer. There are many factors that come into play when determining where to anatomically place a breast implant. Most women desire a natural look and feel to their breasts. Here are some of the good and bad points. In general most plastic surgeons prefer to place the implant beneath (subpectoral) your chest wall muscle (pectoralis major). The advantages are more of your own soft tissue covering the implant.... more

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

+2

No Cookie-Cutters Allowed

There is no standard approach to Breast Augmentation that works for all possible breast anatomical differences between patients. Placing the implant above the muscle is the appropriate choice in certain circumstances, and creates a natural result, whereas in other situations, implant placement above the muscle would be disastrous. Each approach involves some degree of trade-off or compromise, and the artistry of Plastic Surgery of the Breast is all about the surgeon making the correct... more

Athleo Louis Cambre, MD
Los Angeles Plastic Surgeon

+2

It all depends on your body

Emzy, This is a great question and you will likely hear many different opinions from many different people. That is because there is not a definitive answer and, depending on your body, the answers may be different. Basically, the implants can be placed above the muscle (below the breast) or below the muscle (and the breast). The implant needs to have a sufficient amount of natural tissue covering it to maintain a natural shape. If you do not have much breast tissue and you put the... more

David Shafer, MD
New York Plastic Surgeon

+2

Usually below the muscle / biplanar

The more tissue that covers the implant, the more the implant is hidden. Above the muscle implants tend to ripple more. The outline of the implant is typically much more visible above the muscle (and therefore unnatural). Above the muscle placement also destroys circulation from the chest muscle to the breast above it; this circulation never comes back and makes a subsequent breast lift (especially around the nipple) much more risky. The risk of developing scar tissue requiring... more

Brent Moelleken, MD
Beverly Hills Plastic Surgeon

+2

Your body makes all the difference!

There are many ways to achieve exceptional results in breast enhancement. Implant type, positioning and incision placement all have an effect on the eventual outcome. Below the muscle placement generally results in the most natural appearance as it provides one more layer of coverage to the implants. Occasionally, in the case of breasts with moderate droop, a "dual plane" placement is better, as this technique avoids a "double bubble" deformity. Finally, some surgeons... more

David L. Kaufman, MD
Folsom Plastic Surgeon

+2

The operation must be tailored to the patient

The short answer is that both planes can provide a very nice result, but the key is that your individual anatomy has to be evaluated and the advantages and disadvantages of each option reviewed. A couple of other points to add: In my opinion, saline implants should really not be used above the muscle as they will create a very unnatural look in most cases. If there is a need to place the implant above the muscle, I usually recommend silicone implants to my patients. In my experience... more

Shahram Salemy, MD
Seattle Plastic Surgeon

+2

Below the muscle is better in my book!

The benefits of under the muscle placement outweigh the downsides. First, when I talk about under the muscle, I am talking about a dual plane technique whereby the lower part of the implant is under the breast tissue and the upper part of the implant is under the muscle. If the implant is placed under the entire muscle, the implant is typically pushed out and down, spreading the cleavage unnaturally wide. Second, the benefits of placing them in the dual plane position are many. a) decreased... more

Robert M. Freund, MD
New York Plastic Surgeon

+1

Silicone implants under muscle give more of a natural look

This has been interesting reading for me as I am a plastic surgeon who specializes in BA. I perform about 450 such procedures annually. Let me tell you what I have learned. The best way to choose your implant is to forget about cc’s. Let the surgeon do that…it’s his job. What you should do is be able to communicate the look you are trying to achieve and often pictures of other people is a good place to start. There have been many times when a patient has told me they... more

Leonard Hochstein, MD
Miami Plastic Surgeon

+1

Natural Breast Implant Appearance

Whether one places the breast implants above or below the muscle is perhaps not as important as the size and shape of the implant based upon the base dimensions. In general, implants placed below the muscle tend to look more natural and have less chance of having a capsular contracture (getting hard). If the patient has adequate breast tissue both saline and silicone implants look quite similar. If there is no breast tissue it is often best to use silicone gel in my experience. more

Rod J. Rohrich, MD
Dallas Plastic Surgeon

+1

Natural Looking Breast Implants

Hello, While no breast implant will look and feel 100% natural forever, the are several commonly accepted methods of making breast implants look as natural as possible. 1. Submuscular Placement- For most younger patients with relatively small breasts and little to no sagging, a breast implant placed under the muscle will provide a more natural, durable result than those placed above the muscle. 2. Silicone Implant- Most plastic surgeons agree that silicone... more

Jaime Perez MD
Tampa Plastic Surgeon

www.jaimeperezmd.com

+1

Under And Over gives the most natural result: Biplanar augmentation

At one time breast implants were placed either over the pectoral muscle (subglandular) or completely under it (subpectoral). The most natural results in my hands over the last 20 years are achieved by placing the implant in a biplanar position with the upper 60% - 70% or the implant under the muscle and the lower portion in the subglandular position. To accomplish this the lower muscle attachments are released and the muscle is allowed to "window shade" upward. ... more

Lawrence Shaw, MD
Scottsdale Plastic Surgeon

www.theshawcenter.com

+1

" Natural" appearing implants

Honestly, the whole concept of placing an artificial device under the breast or chest muscle is anything but natural. However a few factors can assist you in your decision process. In general, placing the implant under the chest muscle allows for more of your own tissues to cover the inherent wrinkles in all implants(less in silicone, more in saline). Also implant size and shape have a significant contribution to the appearance. A detailed consultation to assess your anatomy with... more

William Loutfy, MD
Albuquerque Plastic Surgeon

acfps.com

+1

Under or over the muscle, which is more natural?

Women in my practice want the same thing, to look natural and well proportioned. The best way to achieve this is placing the implants behind the muscle. This creates a naturally full slope and prevents the bulge or shelf that is sometimes seen with implants on top of the muscle. There are many factors that come into play when selecting an implant, but under the muscle placement does give a more natural appearance, and is the preferred position down the road,... more

Beverly Friedlander, MD
Short Hills Plastic Surgeon

+1

I believe under the muscle

I believe placing breast implants under the muscle, makes the result more natural because it best disguises the breast implant. Nothing says fake more then a subglandular implant with visibility and wrippling. In particular, I do not place saline implants over the muscle. In addition, the sub-muscular position decrease the rate of capsular contracture, which would cause gross deformity of the breast, definitely less natural.

Vishnu Rumalla, MD
Dallas Plastic Surgeon

+1

Your appearance depends on your preoperative appearance and the implant chosen.

If you are thin with very little breast tissue, implants under the muscle look more natural in my opinion. Patients who have large breasts already or are a bit overweight might look just as normal on top.

Brian K. Brzowski, MD
Salt Lake City Plastic Surgeon

www.brzowski.com

+1

Natural implants depend on your anatomy and the size of the implants.

How natural your implants look depends on selecting the right implant and what your body looks like before your surgery. If you try to put an 800 cc silicone implant in a 5'2", 100 lb woman, they won't look natural no matter how you place them. Select a more modest sized implant in the average person and you can get natural results in either plane. Bottom line is if you have an open and honest discussion with your plastic surgeon about what your goals are, they can tell you... more

Jason Brett Lichten, MD
Columbus Plastic Surgeon

+1

Implant plane

With few exceptions, the submuscular plane provides the most natural results. In particular, submuscular placement reduces the incidence of capsular contracture (Hard implants). In reality, most implants are placed in a dual plane. The majority of the implant is submuscular and the lower aspect is subglandular. It is nearly impossible to achieve complete muscle coverage.

Jason R. Hess, MD
San Diego Plastic Surgeon

+1

Most natural augmentation result depends on your anatomy

For women with very little breast tissue and minimal or no sagging, I almost always recommend under the muscle for the most natural result, but for women with a moderate amount of breast tissue and/or sagging, above the muscle is usually going to look more natural.

Amy M. Sprole, MD
Wichita Plastic Surgeon

+1

Both!

I've gotten very natural appearances in both techniques. Choice of implant based on patient's body type is very important. For example, large salin implants placed over the muscle in a patient with thin skin may result in an unnatural appearance.

Marisa Lawrence, MD
Atlanta Plastic Surgeon

+1

Submuscular implant placement usually looks more natural

The best way to create natural looking breasts is to put the implant as far away from the skin surface as possible. Implants below muscle have an extra layer of camouflage (the pectoralis major muscle). The muscle also blunts the upper edge of the implants to prevent the "step-off" look at the junction of the upper chest skin and the upper edge of the implants. Implants placed below muscle look artificial immediately following surgery. However, as the... more

Ronald Friedman, MD
Dallas Plastic Surgeon

+1

Implant placement of optimum result

There is no one ideal approach for all breast augmentation patients. The surgical approach needs to be highly individualized for every patient, based on individual anatomy. A knowledgeable and talented surgeon will make an important assessment of the breast anatomy, such as skin quality, amount of breast tissue, musculature, etc. to decide the best approach. There are three basic categories, with few variations, namely total under the muscle, partial under the muscle and on... more

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon

+1

Breast implant placement is an individual choice

Breast implant placement is an individualized choice. If the woman is very athletic and works out a lot with weights and does push ups, I would recommend over the muscle. When the pectoralis muscle is worked, the majority of experience movement in the implant by its being displaced upward toward the shoulder. This occurs in most woman. I If the woman has little breast tissue and is thin, then I recommend the implant be placed under the muscle. The... more

Gary H. Manchester, MD
San Diego Plastic Surgeon

www.manchesterclinic.com

+1

Breast implant placement for natural appearance

In my experience, either approach can give a very natural appearance. The way I discuss this issue with my patients is to show them photos of both types. Your surgeon might make some recommendations based on your body type, but overall it's a very individualized choice in which you should participate.

Deason Dunagan, MD
Huntsville Plastic Surgeon

+1

Implant position

As you are already aware, there are many opinions regarding what will implant position will give a better result. I prefer to view it in a different light. The advantages of going over the muscle include no distortion of the breasts with muscle contraction, slightly better elevation of the nipple (but with dual plane techniques, this is no longer true), and less pain. Unfortunately in my experience, larger implants will droop more and over time, over the muscle tends to... more

Curtis Wong, MD
Redding Plastic Surgeon

+1

Breast implants behind the muscle for a more natural result

The pectoral muscle will conceal the edges of the implant, resulting a more natural appearing augmentation. With a properly selected implant in the sub-muscular position, the natural curves and folds of your breast can be preserved- its your breast, just 'pushed forward'- this is possible with reasonably sized implants that fit within the confines of your breast dimensions. This type of augmentation tends to last the longest.

Scott Sattler, MD
Bellevue Plastic Surgeon

+1

Under the muscle is usually prefered

In my practice I place most implants under the muscle. The best position for an implant whether under the muscle, (sub-muscular), or over the muscle, (sub glandular), depend upon the anatomy of the woman. Several factors need to be considered when determining implant position: The amount of tissue covering the implant. In most women who are thin with little breast tissue, it is usually better to go under the muscle. The extra layer of tissue over the implant usually provides a better... more

James H. Schmidt, MD
Sarasota Plastic Surgeon

+1

Breast Implant Position Under or Over The Muscle...Which is best!

For most patients placing the implants under the muscle will give a more natural appearance and is a more durable result. There is less stretching of the skin and breast tissue and less drooping over time. There is also some evidence that the chance of developing capsular contracture may be reduced in this position. A well positioned implant, under the muscle through a inframammary incision gives an excellent result and is very reproducible There are very specific situations where placing... more

David L. Mobley, MD
Sarasota Plastic Surgeon

sarasotaplasticsurgery.com

+1

Under the Muscle usually More Natural Looking

Many factors can lead to a "natural" or "un-natural" looking result. Each woman is different as to size, shape, and soft tissue coverage. The more natural results usually have more soft tissue coverage. One way to help achieve this is to put the implant under the muscle. Now there is more soft tissue on top of the implant. Again, everyone is different. Very important to communitace your goals to your board certified plastic surgeon. Together you can see what is or... more

Jeffrey Roth, MD
Las Vegas Plastic Surgeon

+1

Natural Breast Augmentation

Under the muscle generally gives a more natural result -- each patient presents with different anatomy (a woman's breast are sisters not identical twins!) and therefore must be seen and examined by a Board Certified Plastic Surgeon. Larger implants and implants with higher profiles give a less "natural" look.

John Philip Connors III, MD
Atlanta Plastic Surgeon

+1

Breast augmentation - under or over the muscle

Placing breast implants under the muscle helps to hide the edges of the implant especially in women with a thin fat layer under the skin. Saline implants should not be placed over the muscle as the edges may be readily palpable (easily felt) or visible. Silicone implants, with their smoother contours can be placed in either position, under or over the muscle, however placing them under the muscle will conceal them more with thicker tissue therefore giving a more natural appearance. The... more

Sean A. Simon, MD
Miami Plastic Surgeon

+1

Natural breast implants results

Under the muscle generally gives a more natural result -- each patient is different and should be examined by the surgeon to make sure all options are discussed. Using smaller implants also helps give the more 'natural" looking slopes.

Tom J. Pousti, MD
San Diego Plastic Surgeon

+1

Natural breast appearance

A natural breast appearance can be achieved but is based upon many factors. Here are a few. Overdoing the volume or shape of the implant may make it look worse. Having good soft tissue coverage improves the apperance so more often than not, under the muscle looks more natural.

Steven Wallach, MD
Manhattan Plastic Surgeon

+1

Breast implant size and placement affect appearance

In general, the size of breast implant is just as important as the position behind or in front of the muscle in how "natural" the post-op appearance turns out. All things equal, the placement behind the muscle give a much better contour to the upper part of the breast and avoids the "bubble" look when you have implants placed in front of the muscle. That is a very simple answer to the question, however. There are many factors to consider such as tissue coverage, and your... more

Bahram Ghaderi, MD
Chicago Plastic Surgeon

+1

Submuscular would be your best choice.

Natural is in the eye of the beholder. However, the submuscular placement is the best option. The benefits to going under the muscle are numerous. Over time, the implants develop a capsule. The tendency for this capsule to tighten or contract is much higher on top of the muscle not under. The skin is not as strong as the muscle, so over time the implant on top of the muscle will droop significantly. The chances of feeling or seeing ripples is much higher when the implant is above the... more

David A. Dreyfuss, MD
Chicago Plastic Surgeon

+1

That depends on your particular situation...

Unfortunately, there is not a single operation or single position for a breast implant that will give every woman the best, most natural appearance. The best position for a breast implant depends on how much breast tissue you have, how much ptosis, or drooping, of the natural breast tissue there is, and your goals for size and shape. Historically, women with significant amounts of breast tissue, particularly if that tissue was sagging, benefited from an implant placed over the muscle, just... more

Adam David Lowenstein, MD
Santa Barbara Plastic Surgeon

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Which Breast Implant Placement Gives a More Natural Appearance?