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Which Breast Implant Placement Gives a More Natural Appearance?

When getting breast implants, what gives a more natural appearance, going under or over the muscle?

Asked 39 months ago by emzy in Australia

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natural

+11

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

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Michael Law, MD

Raleigh-Durham Plastic Surgeon

ASAPS ASPS

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... more

Karen M. Horton, MD

San Francisco Plastic Surgeon

ASAPS ASPS

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

ASAPS ASPS

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

ASAPS ASPS

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

ASPS

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

ASPS

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

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Tracy Pfeifer, MD

Manhattan Plastic Surgeon

ASAPS ASPS

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

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

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Kenneth R. Francis, MD

Manhattan Plastic Surgeon

ASAPS ASPS

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

ASPS

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

ASAPS ASPS

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

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Paul C. Zwiebel, MD

Denver Plastic Surgeon

ASAPS ASPS

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

ASPS

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

ASAPS ASPS

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

ASPS

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

ASAPS ASPS

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

ASPS

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

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

ASAPS ASPS

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

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

Denver Plastic Surgeon

ASAPS ASPS

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

ASAPS ASPS

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

ASPS

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

ASAPS ASPS

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