Breast augmentation - under or over muscle? (Photo)

I'm considering breast augmentation and have a question in placing the implants under or over muscle. Referring to my photos, what recommendation is best to achieve a full round fake high upper look?

Doctor Answers 12

Breast implant pocket

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Hi DingDongDing

If you are after a full round fake high upper look, just go above the muscle.

There are pros and cons to going above or below the muscle, but if the look of your implants outweighs other decision making factors, then above the muscle is the right choice for you.

Good Luck

Dr Gavin Sandercoe

Breast Augmentation Placement

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There are pros and cons to both so it's really going to depend on you and your desired outcome. I would suggest that you schedule an appointment with a board certified plastic surgeon in your area for an in person consultation. It's really the only way to determine what size, type and placement of implant is right for you. Best, Dr. Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Breast augmentation - under or over muscle

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There are many pros and cons for going over or under the muscle. Some pros of going under the muscle include less chance of being able to feel or see an implant, less chance of sagging in the future, lower complication rates and easier to get mammograms in the future. Pros going over the muscle include decreased discomfort and often a quicker time to healing. Your surgeon should be able to tell you in your particular case recommendations. Often, if one is trying to achieve a high fake look, the type of implant is more important.

Breast augmentation - under or over muscle?

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Thank you for your question and photos.  
Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.   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.  

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular).
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.

I hope this, and the attached link, helps. Best wishes.

Fake look

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Thanks for sharing the photos and your goals.
If you desire a full fake look, then the decision is easy you go above the muscle using round implants.
I hope this helps and good luck.

Over or Under

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I think you would do well with either approach.

Generally when there is enough soft tissue I recommend the subfascial pocket as it avoid the risk of the implant moving with contraction of the pectorals muscle.

Given your aesthetic aims, a round high profile implant in a subfascial pocket would serve you well.

Best wishes


Round fake look

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You will get different opinions from different surgeons, but I would say that there is little doubt that subglandular or subfascial implants (above the muscle) are better suited to give a round, 'fake' look. The downside is that some risks such as rippling are increased, but you would avoid other issues typical of submuscular implants (breast animation, for example).

Ciro Adamo, PhD, MD
Italy Plastic Surgeon
5.0 out of 5 stars 18 reviews

Over the muscle

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Hi. I would recommend textured round subglandular implants (over the muscle). You will need at least full projecting implants and relatively large as you have a lot of loose skin to fill. Regards. Damien

Breast augmentation - under or over muscle?

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Thank you for your questions and photos.  In general, there are several ways to create the augmented ("full and fake") look.  The first is to place the implants above the muscle to accentuate the upper pole of the device.  You should also consider higher projecting implants and a size that is in the upper range of normal for your frame.  Good luck!

Hunter Moyer, MD
Rapid City Plastic Surgeon

Over or Under

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 I will usually recommend that implants be placed under the muscle. There are many advantages to this location. There is better coverage towards the cleavage and you'll see less wrinkling. Also, the capsular contracture rate, which is the chance of them feeling firm, is much lower with the implant under the muscle. Screening mammography may likewise be easier with the implant not directly under the breast. The only real advantage for me to placing the implant above the muscle is it slightly more comfortable for the first few days. I believe that with a dual plane approach, an under the muscle placement of the implant can give the exact same fill to a lax skin envelope that the sub glandular implant can. If you want a full upper pole I would recommend a maximally filled gel implant like the Natrelle InSpira placed under the muscle. Good luck.

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.