Is Above Muscle Breast Implant Placement the Best Approach?

I am 37 years old and have nursed my 3 children. I used to be a C cup, but now my breast are just "empty" and saggy. My surgeon says I am not quite needing a Breast lift, but is recommending Silicone Breast Implants above the muscle. I don't know anyone with implants above the muscle. Is this the right approach?

Doctor Answers 13

Over the muscle implants

In your situation, over the muscle or subglandular implantation is the best. You have no real breast droop, just loss of volume. I would recommend silicone implants as well over the muscle. It would give you a more natural look, feel, and shape.

Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Is Above Muscle Breast Implant Placement the Best Approach?

Thank you for the question. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well. 

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  that can be seen with breast implants placed in these sub muscular position.    Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Under the muscle is best

Surgeons are divided on the topic of implants on top of the muscle vs. under the muscle.  There are several disadvantages of implants on top of the muscle including more sagging over time, easier to see and feel the implants, higher risk of capsular contracure, higher risk of rippling, more interference with visualizing breast tissue on a mammagram and more risk of the nipples losing their blood supply with a future breast lift.  These problems far out-weigh the scars from getting a lift. If you need a lift, get a lift. Keep your implants under the muscle.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Breast Implants

Each surgeon has his or her preferred approach to the problem you present with. Placing gel implants on top of the muscle is certainly one choice but submuscular placement has a decreased risk of breast hardness. I cannot say more without examining you

Richard Linderman, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 9 reviews

Pocket position

I prefer to palce breast impalnts below the muscle which is really a dual plane approach. This will protect the upper pole and limit rippling there.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Is Above Muscle Breast Implant Placement the Best Approach?

Breast implants placed above the muscle are the best way to restore volume with "deflated" breasts. However tradeoffs include possible interference with mammograms, increased risk of capsular contractiure, and more prominent result.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast implant position.


Your surgeon is absolutely right.  To correct mild sagging such as you have, the best thing to do is to put implants over the muscle.  This is what we do in New York, and t works great.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Breast implant placement

Most breast implants are inserted under the pectoral muscle (subpectoral). The reason for this is a lower rate of capsular contracture (scar tissue), more natural appearance, and easier mammogram interpretation. This is not to imply that over or in front of the pectoral muscle is incorrect, however there are many more advantages with the subpectoral approach.

In your particular case, the recommendation of placing the implant in front of the muscle is likely to avoid any need for a breast lift as the implant will help advance your breast tissue forward. As I look at your photo, it appears you would most likely do fine with a subpectoral implant-of course your surgeon has the benefit of being able to actually examine you, which I do not.

Please discuss this further with your plastic surgeon prior to selecting the implant location. This is elective surgery, so you have time to do your research and come to an informed decision.

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

Placement of breast implants below or above the muscle

 I believe you should almost always go below the muscle (partial submuscular or dual plane are the terms).  These give better mammograms, look more natural, and probably have less capsular contractures.  Above the muscle implants can look like a ball in sock and matronly.  Not so pretty.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Above vs below the muscle augmentation

By the image you posted, you have some laxity of your skin and some mild asymmetry as well. My personal preference would be to place your implants partially under the muscle with what is referred to as a dual plane release (relasing a bit more of the muscle). This would lend you a better upper and middle breast coverage but I would have to examine you to see if this is OK without some form of a lift. It depends as well on the size implant you chose too.

I rarely perform above the muscle breast augmentation in a thin woman due to increased implant exposure, rippling, possibly increased rate of capsular contracture, etc. Havingsaid that, you should discuss all of your options with your plastic surgeon so that you can come to a plan together. I wish you well.

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 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.