Would ultra high profile silicone under the muscle give the same look as a moderate plus over the muscle?

Basically, after reading the majority of the opinions on this app, it seems an overwhelming majority is pretty much anti-over the muscle, I'm now nervous about it..

Doctor Answers 8

Breast augmentation

Hello and thank you for your question. There are several advantages to under the muscle, including less risk of capsular contracture, more natural look and feel, and less rippling.  The size and profile of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  This entire surgery can be performed with a small incision technique.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

New York Plastic Surgeon
5.0 out of 5 stars 67 reviews

Under vs Over the muscle

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

It's difficult to perform direct comparison of different types of implants and the expected results without an exam

There are so many different factors to consider when choosing the best implant to meet a patient's goals.  We need to remember that implants have not only volume to consider, but they also have different dimensions.  The various profile types that the manufacturers use are all based upon different dimensions for different profile types, and those vary with the volume of the implant too.  In general, the higher the profile of the implant, with "ultra high" profile being the highest, means that the implant is narrower in diameter and high in projection forward than the lower profiles, like moderate, moderate plus, or other terms used by different manufacturers to denote essentially the same thing.  Thus, it will look much rounder and higher than any other implants in that same volume range.  For some ladies this is an advantage, as they particularly want a rounder, fuller upper breast contour.  For those ladies who don't want that look and may prefer a more gently sloping, "natural" contour to the upper breasts, that implant probably won't do.  With respect to implants being placed above the muscle as opposed to below, the general rule of thumb is that the muscle provides some camouflage and softening of the implant contour, so implants placed below the muscle won't appear quite as "fake" or round as implants placed above.  This is particularly important to note the higher the profile of the implants, as higher profile implants, including and especially ultra high profile implants, will appear more distinctly round and "fake" if placed above the muscle than they will below.  In addition, it's worth noting that placing the implants above the muscle creates a higher risk of capsule contracture, especially when using implants with a smooth surface, which most ultra high profile implants have.  I wouldn't say most surgeons, myself included, are necessarily "anti-over the muscle."  It's a valid way to place implants, and for some ladies it may be the best way.  We just have to be aware of any additional risks imparted by the technique or the type of implants themselves.  Be sure to discuss these issues in depth with your surgeon, and if there is something you don't understand or need clarification on, continue asking until it is clear.  Your surgeon should be certified by the American Board of Plastic Surgery, as only board certified surgeons will be sure to have the proper training and experience to guide you toward the right decisions for your body and your preferences.  In addition to being certified by the American Board of Plastic Surgery, the only generally recognized organization which certifies true plastic surgeons and has the term “Plastic Surgery” in its title, your surgeon should also participate in the Maintenance of Certification (MOC) program administered by that board. This program requires that surgeons who participate continue to update their credentials and professional standing regularly, as opposed to practicing on a single lifetime certificate like those plastic surgeons who elect not to participate. To find further information about this program and any surgeons you might consider for your surgery, I suggest visiting these sites: abplsurg.org and abms.org. Good luck.

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

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. Schwartz

Board Certified Plastic Surgeon



Would ultra high profile silicone under the muscle give the same look as a moderate plus over the muscle?

Thank you for the question.  Online consultants will not be able to provide you with specific enough advice to be truly helpful. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 

Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as  “natural” or "C or D cup” to "too big on me" etc means different things to different people and therefore prove unhelpful.

 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery,  after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast  augmentation surgery concerns) helps. Best wishes. 

Implants of a given profile look the same above or below the muscle.

There is no difference in the aesthetic outcome of breast augmentation if the implants are placed over the muscle versus below the muscle.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Breast implant placement

There are pros and cons to pre/post muscle placement. It really depends on your anatomy and the look you are trying to achieve. I recommend having a thorough discussion with your plastic surgeon to insure that you are on "the same page" before proceeding to the operating room.

Asaf Yalif, MD
Roswell Plastic Surgeon
5.0 out of 5 stars 6 reviews

Varying profiles and pockets

I agree with the answers above.  3D imaging is going to be the best tool to help you visualize your results.  Subglandular implants are still only typically reserved for special circumstances as the benefits rarely outweigh the risks.  Good luck!

Jon Kurkjian, MD
Fort Worth 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.