Breast Augmentation - do over-the-muscle breast implants make asymmetry of the breast more noticeable?

I am considering breast implants. I have had two consults, and one doctor said under the muscle, and the other said over the muscle to achieve the most natural and beautiful results. I am about a 34B and have plenty of breast tissue. I am concerned about symmetry. One breast is slightly smaller and points downward a little while the other is perky and points straight. Does one way (over or under the muscle) get better results when addressing asymmetry?

Doctor Answers 8


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That's a great question. I don't think it will make a difference in your example. I'm saying that because you said you have a lot of breast tissue to cover the implant and in that particular situation I don't think the relationship of the implant to the muscle is as important as it is in those patients who have very little soft tissue coverage of the implant. In that case I think putting it under the muscle may help to camouflage some of the asymmetries

Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 reviews

Symmetry following breast augmentation

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Breast implants are designed to add volume to the breasts.  They don't do much to change the basic shape of the breasts.  If you have asymmetry now, they you would probably have asymmetry afterwards regardless of whether the implants are above or below the muscle unless something is done to specifically address the asymmetry.  If your nipples are different then some sort of nipple/areola adjustment may be required.  I would suggest that you schedule a consultation with a board-certified plastic surgeon who can examine you in person and review your options with you.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews

Breast implants, photos

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Thanks for sharing your concerns with us. I recommend you to send your photos to us to give you the advices you want and need.Kind regards

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 369 reviews

Breast Asymmetry

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Every type of breast augmentation technique is going to impact your natural breast asymmetry and will likely make it more noticeable as your breasts get bigger. It is important that you review your concerns about your asymmetry before surgery so you can be aware of whether additional techniques can be done at the same time as your implants to improve it or whether its persistence is an expected outcome for which nothing can be done to improve it.

Breast Implants/Breast Reduction/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

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I appreciate your question. The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.   Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection. The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery. Best of luck! Dr. SchwartzBoard Certified Plastic Surgeon Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon #RealSelfCORESurgeon


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Without photos it is difficult to know. In general, implants make your breasts bigger - regardless of where they are placed. Therefore, any existing asymmetry will still be present. Some impact on asymmetry of size/volume can be made by using differing dimensions/volumes in the implants though that never makes them "identical twins". Expect the nipple asymmetry to persist unless a procedure is done with the areola to improve that.

Breast Augmentation - do over-the-muscle breast implants make asymmetry of the breast more noticeable?

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Thank you for sharing your excellent question.  In most cases equal improvement in asymmetry can be accomplished with placement of implants either above or below the muscle.  In most cases going below the muscle is best as it supplies additional soft tissue coverage to the implant - leading to less visibility and palpability - while trending towards fewer complications and more natural results.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Over or under

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Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a more narrow cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. All things considered, I don't believe there's any advantage to either placement method when it comes to addressing asymmetry. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 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.