Under the muscle or over the muscle?

Why do some people get their implants under the muscle and other people get them over the muscle? I am petite - 5'2 110 pounds, 34B cup. Would it be okay for me to get implants over the muscle? (I want the shorter recovery time)

Doctor Answers 19

Under the Muscle (Submuscular) or Over the Muscle (Subglandular)

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Thank you for your question.

The best way to determine the position of the implant that would meet your expectations is to schedule a consultation with a surgeon who is Certified by the American Board of Plastic Surgery. At that consultation a thorough breast examination will be performed that will include detailed measurements including breast size, shape and width, assessment of your skin quality, and any asymmetry of the breasts. This exam will allow your surgeon to help you choose a breast implant size and position that will be appropriate for you and your goals.

Given the fact that you are petite, you most likely do not have a lot of soft tissue coverage for the implant. I would consider a submuscular position of the implant. I believe that, in your case, the submuscular implant would look more natural and feel more natural. The other benefit is that there is a lower capsular contracture rate under the muscle. Breast augmentation is not a cookie cutter surgery. Depending on the person, sometimes a subglandular position is a better option.

Be sure to book a consultation with a Board Certified Plastic Surgeon so they can perform a thorough examination, discuss your options of breast implant placement, and review the risks and benefits of either position.

I hope this helps and best of luck with your breast augmentation!

Troy Plastic Surgeon

Rapid Recovery

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Sub pectoral placement of breast implants does not necessarily mean a long recovery; most of my patients are driving and doing all normal daily activities with in 2-3 days.  Regardless, it's a bad idea to choose implant position based on such a temporary event, when the repercussions of the decision will be with you for the rest of your life. 

The benefits of sub pectoral placement far exceed the risks, or any benefit form subglandular placement.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Breast Augmentation Under or Above the Muscle?

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Thank you for your question. I advise the vast majority of my patients to place their new breast implants partially beneath the pectoral muscle. This provides for less obstruction of view for future mammograms and a smoother transition in the upper chest area especially important in women with thin tissue. Occasionally, patients who are professional dancers or who lift heavy weights wish to consider placement above the muscle beneath the breast gland itself (suprapectoral). I think that this gives a somewhat less subtle and more obvious look and but is undesirable in circumstances were a patient chooses saline implants or their breast tissue is quite thin.  Enjoy the video above to get more information.
Meet with and discuss your options carefully with an ABPS board-certified plastic surgeon of your choosing. Warm regards.

Jon A Perlman M.D., F ACS
Certified, American Board of Plastic Surgery
ABC-TV Extreme Makeover Plastic Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 33 reviews

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Both Have Pros & Cons

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Thank you for your question, for the majority of my patients, I recommend under the muscle placement with silicone implants for a more natural look, with a lower risk of complications. One of the few situations where I recommend going over the muscle, is if the patient is a body builder and competing in a lot of shows where the pectoralis muscle is flexed. In that case, the muscle is very active and one gets a lot of animation with the implant. For either placement, there are circumstances based on a patient’s anatomy that one may be more beneficial than the other so it is important to be examined by a plastic surgeon to make an informed decision.

Kamran Azad, MD
Pasadena Physician
5.0 out of 5 stars 13 reviews

Sub-muscular is almost always the best way to go

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In my opinion, sub-muscular placement of breast implants is almost always the best way to go with breast augmentation surgery. In reality, the pectoralis major muscle covers the upper and middle part of the implant, so it is more accurately a dual plane or partial muscle coverage. Having the muscle coverage provides more padding to reduce palpability of the implants, it creates a more predictable appearance in the cleavage area, and it lowers the risk of capsular contracture (scar hardening) dramatically, especially with smooth implants. If performed by an experienced and skilled surgeon, the recovery time is not that much different, and you will be trading a little extra soreness upfront for lower risks and a better long term result. Especially in a thinner patient like yourself, I would be very wary about a surgeon recommending subglandular (over the muscle) implant placement, particularly in combination with smooth implants. Best of luck!

Robert Cohen, MD
Santa Monica Plastic Surgeon
5.0 out of 5 stars 58 reviews

Submuscular vs Subglandular

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Hello and thank you for your question. I wish you the best in finding the right answers, and there are a lot of great answers and information on the forum and on the physician's websites. Remember, it is best to see a Board Certified Plastic Surgeon who can in person examine you, take key measurements and go over with you, your specific aesthetic goals. Bringing several photos of your "ideal" look can be helpful as well. There are several advantages and different reasons for placing the implants in a sub-muscular position versus above the muscle notably the rate of capsular contracture and the risk of implant show/rippling. Your Board Certified Plastic Surgeon can review these and others with you. Best of luck.

Benjamin J. Cousins M.D.
Board Certified Plastic Surgeon

Benjamin J. Cousins, MD
Miami Beach Plastic Surgeon
5.0 out of 5 stars 10 reviews

Under the muscle vs over the muscle

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Under the muscle placement has a lower complication rate.

It also preserves the blood supply from the pectoral muscle to the breast, which is divided if the implant is placed over the muscle.

Implants generally look more realistic when placed under the muscle.

The recovery difference is minimal with modern minimal touch techniques.  Patients are generally sore for a few days and should try to use their arms as gently as possible for two weeks.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Implants under or over the muscle?

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Thank you for your question. In my practice I always tell new breast augmentation patients to think of
these as their 'first' pair of implants. We know that implants are not lifetime devices, so it is important
to think through the best placement position. Yes, submuscular placement generally has a slightly longer
recovery time. But, over the long run I do believe that it is the best position for most patients for a 
variety of reasons. In my experience, most patients obtain a softer, more natural, and more durable result
with submuscular implants.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 20 reviews

Breast Augmentation Under muscle vs over muscle

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Hello, and thank you for your questions.

The simplest answer is that you do not have enough natural breast tissue for adequate cover for the implant.  Therefore, going sub-muscular will ultimately look and feel more natural-giving you a better result.

Healing time will honestly not differ all that much.  A breast augmentation is one of the shortest recovery periods for cosmetic procedure.  Surgery will take about an hour, you can go back to work in days (if you do not lift over 10lbs+ regularly), and you can return to exercise in six weeks.

For subglandular implants without adequate tissue coverage- just think of a pillow under a sheet.  Sub-muscular will be a pillow under a nice thick down blanket.

Please make sure you choose a board certified plastic surgeon when moving forward.

All the best,

Dr. Obeng
Beverly Hills, CA 

Michael K. Obeng, MD, FACS
Beverly Hills Plastic Surgeon

Over the muscle vs under the muscle placement. I always go under!

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It is advisable for thinner and smaller women to go under the muscle.  Your breasts are naturally attached to the muscle and there are important supporting ligaments which hold the breast on the chest.  If you go over the muscle those ligaments get cut and the breast tends to stretch and elongate over time leading to a saggy breast.  Going under the muscle does not divide the natural breast supporting ligaments and has additional tissue coverage in the upper part of the breast which gives the breast a much more natural look.  Thin women who go over the muscle their breast look fake like two coconuts on the chest.  Also with less tissue there is a greater chance of rippling or seeing imperfections in the implant.  Plus studies have shown lower incidence of capsule contracture rates in submuscular breast implant placement compared with subglandular.  A shorter recovery time means nothing for a set of implants you will get which last for years.  You should not make a decision of a week difference in recovery for something that will last 10 years or more.  Also having less pain which is perceived as healing faster is not true.  Just because the pain is less the internal pocket still takes time to heal and being active will still increase your chances of developing a breast capsule. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 106 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.