How Do Saline Breast Implants Look if Placed over the Muscle?

The look of implants - either saline or silicone - is dependent on your overlying skin. If you are able to pinch a significant amount of skin (more than 2 cm) then you may do well with subglandular (over the muscle) breast implants. Otherwise, you may do better with submuscular implants which would have that added coverage of the muscle tissue. Good luck with your surgery.

I typically do not recommend implants to be placed directly under the breast tissue unless a previously placed submuscular implant is causing problems (scar contracture, etc.). Their are surgeons who will place implants under the gland to compensate for dropping/ sagging tissue...I think this results in an elongated (rock-in-sock) appearance that I personally do not care for...But I have heard patients say, when you see 10 different plastic surgeons, you may get 10 different opinions on what needs to be done.
So, see as many surgeons (Board Certified Plastic Surgeons) as you feel comfortable with, review their results, above and below the muscle, and evaluate what results most exemplify your goals and go with that surgeon!
I hope this abbreviated response helps!
Dr. C

Breast implants placed over the muscle will have less distortion by the muscle, though the upper part of the implant will likely be noticeable. It can give a somewhat "unnatural" look and feel, though this depends on how much native breast tissue you have. Advantages include easier recovery, less implant movement with muscle contraction and maintenance of muscle strength. It is a valid option in the right patient.

The appearance of implants placed above the muscle, in general, tend to provide greater fullness to the upper pole and a less natural, more "augmented" look. Depending on the amount of breast tissue you have, saline implants may be more prone to showing rippling of the implant and will be more prone to capsular contracture (hard, painful scar tissue around the implant).
Although I place most breast implants behind the muscle, if I have a reason to place the implant in front of the muscle, unless the patient has a significant amount of natural breast tissue, I will usually try to steer the patient towards silicone implants.
Hope this helps. Best of luck.

The answer depends on how much breast tissue you have to start with. If you have very little breast tissue, then you will most likely be able to see the implant and get the "implant" look. If you have a moderate amount of breast tissue, then you will most likely have a more natural look. Consider placing the implants under the muscle or silicone implants for a more natural look and feel. Good luck!

It really depends on the size of the implants and the amount of breast tissue. I often use an oversimplified analogy to demonstrate this.
If you take a baseball and cover it with a silk sheet, you will see everything. If you cover it with a thick comforter, you may bareley notice it. However, if you change this to a volleyball, it will be a dramatic difference. Does this make any sense?

I generally do not recommend saline implants above the muscle. It may be acceptable if you have enough soft tissue coverage, but the risk of palpable implant edges and rippling of the implant is higher.
There are pro's and con's to any approach and breast augmentation is not a "one size fits all" operation.
I would ask your doctor about the options you have and then decide which approach is best. Good luck!

You need to go to a Plastic surgeon with experience.  I have had very nice success in a select group of patients.  First and foremost, you need good tissue coverage to avoid rippling.  The new silicone implants are more ideal for the subglandular pocket.

I like saline implants above the muscle when the patient...

...already has a fair amount of breast tissue.

Saline implants tend to ripple more than silicone.
Hence, those implants need some sort of coverage to camouflage that rippling.
That coverage can come from the muscle or from breast tissue.
If a woman's breasts are already big, but she would like them even bigger, placing implants on top of the muscle is usually OK.


...wants the most natural results when she exercises (nearly) naked(!)

The breasts are naturally on top of the muscles.
Therefore, if the muscles move, the overlying breasts shouldn't move that much.
However, if the implants are beneath the muscles, the breasts might move unnaturally when the muscles contract.
Since most women don't exercise naked, this is a minor issue for most patients.
Nevertheless, some women do compete in sports in small bikinis, and they are aware of breast distortions with shoulder/chest muscle contractions (such as beach volleyball players, surfers, body builders...see below)


...is a body builder.

Body builders have very well developed muscles.
Contraction of those big muscles would significantly distort the positions of sub-muscular implants.
These women do pose nearly naked (in small bikinis) while flexing their muscles.
Even though these women do not have a lot of body fat, implants on top of the muscle are generally better.
In competitions, the rippling of the implants looks less bad than implant distortion.


...has droopy breasts and prefers to avoid formal lift-up procedures

Implants themselves provide breast rejuvenation.
The muscles tend to mute the rejuvenative/lift-up effects of breast augmentations.
Even though many women need mastopexies (lift-up surgeries) at the same time as their augmentations, some patients prefer to avoid the additional scars of mastopexies and accept the limitations of implants on top of the muscles.


...is looking for a quicker recovery

Most breast implants surgeries do not require a long recovery.
However, positioning of the implants below the muscle is more uncomfortable.
Staying on top of the muscle is much less painful.



Generally, I use silicone implants when patients choose to have their augmentations on top of the muscle. Or, better yet, I place implants beneath the muscle in 90% of circumstances...

to minimize rippling
to reduce excess scar tissue around the implants (known as capsular contracture)

For most patients seeking breast augmentation, a saline implant looks better if it is under the pectoralis muscle. Most of the augmentation patients don't the enough soft tissue coverage to camouflage the rippling effects of the saline implant on the upper breast pole noted when the patient is in the upright standing position.
It takes at least 2.5 to 3.0cm of soft tissue coverage to be able to use a saline implant in the sub glandular position and then over time as hormonal, metabolic and signs of aging occur, the soft tissue coverage can thin out and the breast may look like a water bag, not pretty. Gel implants work better over the muscle as opposed to saline.