Over or under muscle? (Photo)

i am 29 years old mother of 2 very athletic i am scheduled for breast implants july 22. i want the rounder fake look so decided to go with 500cc smooth round high profile mentor implants i was told i should go subglandular but feel i should go submuscular if i do will it have a huge impact on my workouts forever or just through the healing process??

Doctor Answers 11

Above or below the muscle

If you want the fake look, then go above the muscle.  This will give the rounder look you desire.   It will also prevent animation deformity with pectoralis muscle contracture.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon 

Atlanta Plastic Surgeon
4.9 out of 5 stars 47 reviews

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 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.8 out of 5 stars 96 reviews

Over or beneath the muscle with implants?

This is one of the most asked questions by patients when considering breast augmentation.  There are surgeons who only place implants above, and surgeons who only place implants below the muscle.  But there are actually pro's and con's of each approach.  One approach is never always superior to the other.  Using a textured implant above the muscle can help decrease the risk of capsular contracture if the subglandular option is used.  Also, the muscle really doesn't "hold" the implant up as in most cases, including yours, it is likely that the bottom of the muscle will have to be released or you will probably need a mastopexy (breast lift) if it isn't.  In athletic patients who work out frequently and have enough soft tissue coverage, the above muscle route can be an excellent choice.    Good luck.

Dean Fardo, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 13 reviews

It depends

It really does.  I won't repeat the excellent points that have been made by some about the pros and cons of each approach.  I will add the following:

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.

-Dr. Chike-Obi

Chuma Chike-Obi, MD
Austin Plastic Surgeon
5.0 out of 5 stars 12 reviews

Always under the muscle

the implant should always be under the muscle as it is softer, better shape, better support, mammograms are better and the capsular contracture rate is lower.

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.

Dr Ennis

Lawrence Scott Ennis, MD, FACS
Pensacola Plastic Surgeon
5.0 out of 5 stars 141 reviews

Submusclar or subglandular?

For my breast augmentation patients, placing breast implants beneath the pectoral muscle and the fascia (dual plane) offers the following 3 major advantages: 1) Decreased rate of capsule contracture 2) More tissue to cover the implant to prevent the implant from being easily seen or felt 3) Support of the breast gland by the underlying muscle to diminish future droop Capsule contracture is the term used to describe the formation of scar tissue around the implant which, when thickened, can make the implant feel hard and round. Although the implant itself remains soft, the scar tissue "squeezes" the implant, which makes the implant itself feel hard. In the submuscular position, the rate of capsule contracture is decreased in general from 15% to 3%. That's a significant difference. "Rippling" occurs when the implant shell is easily felt beneath the skin. With subglandular augmentation, the possibility of this occurring is greater than with the submuscular position. Large studies have shown that the chance of "rippling" is 3 times greater with subglandular augmentation than with submuscular augmentation. Additionally, when implants are placed in the submuscular position "there is the important added advantage of improved mammography." Separating the breast gland from the underlying muscle removes one of the breast "supports." This can lead to accelerated breast droop. Also, by removing the blood supply from the undersurface of the breast, a future breast lift will be more difficult if needed. The advantage of the subglandular placement is that the postoperative recovery is generally shortened by several days and the patient may experience less postoperative discomfort. In addition, there will be less motion of the implant with forceful pectoral contracture. All things considered, the submuscular placement of an implant is the least at risk for the complications of capsule contracture, "rippling" and breast droop.

William R. Burden, MD, FACS
Destin Plastic Surgeon
4.9 out of 5 stars 115 reviews

Over or under the muscle?

The problems with implants above the muscle (sublgandular) from an aesthetic point of view in someone as thin as you is a sharp unnatural transition between the chest wall and the implant which will develop over time in  a high percentage of cases as the swelling completely subsides over many months. Although it is impossible to avoid some animation deformity with a submuscular implant, if a dual plane position is used, in my experience patients find it quite acceptable. I do think for an athletic patient, you are choosing a large implant, and certainly for activities like running you may find them to be uncomfortably large.  Another point to consider is mammography which is routinely done after the age of 40. With subglandular implants a substantial part of the breast is obscured which is not optimal in terms of breast cancer detection.  I think you need to have more discussion with your surgeon both in terms of position and size.

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 97 reviews

Sub Glandular Breast Implant in an Athletic Person

Although it is impossible to tell from your picture, I would highly discourage someone who looks as petite as you going 500 cc. However, because you are athletic, I would never place an implant under your muscle, especially if you are going to use a large implant. They will be a problem always, not just during healing.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Modest ptosis best corrected with sub glandular implants.

I would recommend sub glandular silicone gel implants. There appears to be some modest ptosis of the breasts which is better corrected in a sub glandular position. Sub glandular augmentation hurts less and there is a lower incidence of bottoming out long-term.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Over or under muscle?

There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:

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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.