Over or under muscle? (Photo)
Doctor Answers 11
Above or below the muscle
Breast implants over or under the muscle
Thank you for your question and posting an appropriate picture. You do seem to be a good candidate for breast augmentation. Based on your picture you may be a candidate for placement of the implant over the muscle, however, at the size that you have mentioned placement of the implant under the muscle would be a better choice. If you decide to have the implants placed over the muscle, textured implants would be a better choice as well. Please discuss these options a the board-certified plastic surgeon
Over or beneath the muscle with implants?
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It is important to understand how the volume of implant you select will fit in your lifestyle. It is not absurd to consider jogging, running errands in a brassiere fitted with something that approximates the weight of a breast implant. This can easily be done using some common household items. Don't forget that your ability to function normally is important as well.
Remember that the larger your implants, the more stress your breast tissues will experience over your lifetime. This fact may have implications for future breast surgery such as a breast lift which you may desire later in life.
Always under the muscle
The best way to pick implant size is based on your breast and chest width and not the volume. As the implants get bigger, they get wider. When the width of the implant fits the width of your chest, it will look nice and fit your frame. If the implants are too small, you will have a gap between them and they may look too far apart. If they are too wide, they will make you look top heavy as they may be too wide and stick well out past the sides of your chest.
There are ways to get a bigger or smaller look.This can be done by picking a different implant profile. The higher the profile, the narrower the base width of the implant. If someone has a very narrow chest and wants to be big, they should consider a higher profile implant. If someone has a broad chest and they do not want to be too big but want to avoid the gap and still have cleavage without projection, they should consider a lower profile implant such as a moderate. There are options in between these such as the moderate plus.
Submusclar or subglandular?
Over or under the muscle?
Sub Glandular Breast Implant in an Athletic Person
Modest ptosis best corrected with sub glandular implants.
Over or under muscle?
Subglandular implant benefits:
A shorter recovery time.
Less discomfort initially.
No distortion of the breast when the pectoralis muscle flexes.
Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
Easier surgical procedure.
Larger implants can be placed.
Subglandular implant disadvantages:
The implant may be more visible.
More visible rippling, especially in patients with a small amount of natural breast tissue.
Generally, saline implants do not produce a good result in front of the muscle.
Higher incidence of capsular contraction.
“Bottoming out” in some patients.
Some radiologists have more problems reading a mammogram with an implant in front of the muscle.
Submuscular implant benefits:
Usually results in a better appearance for naturally small breasted women
Less tendency for seeing ripples of the implant.
A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
Lower rate of capsular contraction.
Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.
Submuscular implant disadvantages:
Recovery usually takes a little longer and is more uncomfortable initially.
There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
It is harder to achieve cleavage in women who have widely spaced breasts.
The implants often ride higher on the chest.
Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.
The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach.
Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
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.