Should I Get a BA with Implant in Front of Muscle to Improve Droopiness or Should I Get a BA Behind the Muscle with Mastopexy?

im 5'3'' and I weight 129lbs.i wear a 36 c right now but i don't fill in my bras=if i wear a B cup my boob spills over.went to 5 diff board certified drs & 3of5 told me to do a breast lift with augmentation BEhinD the muscle, 2of5 told me to just do a breast augmentation in front of the muscle to correct the droopiness & that my symmetry wasn't that bad to correct it now that since im only 27 yr/im looking into a 350-375cc implant and want fullness up on top since that is where i need & want it.

Doctor Answers 11

Should I Get a BA with Implant in Front of Muscle to Improve Droopiness or Should I Get a BA Behind the Muscle with Mastopexy?

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement.

Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.  A lift would improve the shape of the breast and your latter statement may be a better option. 

Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.

Hope that this helps! Best wishes for a wonderful result!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Should I Get a BA with Implant in Front of Muscle to Improve Droopiness or Should I Get a BA Behind the Muscle with Mastopexy?

     Either is acceptable as long as you realize that a subglandular augmentation tends to result in faster descent of breast tissue and more tissue thinning due to a lack of intervening muscle tissue.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Above the muscle implant or below the muscle with a lift?

Above or Below the Muscle for Breast Implants?  Choosing the "right" location for breast implant placement can be one of the most stressful and complicated decisions that a patient considering breast augmentation faces.  I have seen numerous patients who became so confused over this issue after three or four consults with different plastic surgeons, all of whom recommended different answers to their situation, that they put their decision to have surgery on hold for months or even years.  While it is always a good idea to thoroughly research a surgery prior to "signing up", it is unfortunate when a patient is given so much conflicting advice from practitioners (who are supposed to be the experts!) that she is  unable to make an informed choice which  she feels confident is the right one given her circumstances.  As a plastic surgeon who has performed over 4000 breast augmentations, my personal philosophy is that there is not a "right"  answer to this question.  I frequently place implants above and below the muscle, and the decision is based on a thorough examination and discussion of each patient's tissues and desires.  The goal is to achieve the result that comes closest to the patient's desired outcome, given the unique circumstances with which each patent presents.  This requires flexibility on the part of both the surgeon and the patient, and frank discussion during the consult to be sure that the result obtained is the one desired by you, the patient, and not just your surgeon.  There are advantages and disadvantages with both of these approaches and each patient should consider these when making her decision.  For example, an implant placed above the muscle may be more prone to developing capsular contracture over time, and there is evidence that choosing a textured implant when choosing to place an implant above the muscle may lessen the risk of contractor.  (Capsular contracture is a term used the describe the condition in which the scar tissue around the implant, known as the capsule,  becomes thickened and creates a firm, and passible distorted breast.)  On the other hand, placement of the implant below the muscle can result in distortion of the implant when the pectorals muscle is flexed, also called and "animation deformity", which can be vexing to many women as it can be extremely distorting and sometimes even painful.  Another common perception is that implants placed above the muscle will always stretch the breast tissues and result in a lower, more droopy breast over time.  This is not necessarily true - a properly sized implant placed above the muscle in a breast with good fibrous tissue support and good quality skin can "hold up" extremely well for many years and can often be the best, most natural result for many patients.  However, there is no doubt that an implant placed below the muscle, if attachments of the muscle are retained at the inferior pole of the breast, can result in more upper pole fullness, or "cleavage" and if this is your desired look, a sub-muscular implant may be the best choice.  While this only begins to explain the advantages and disadvantages to these approaches, it serves to emphasize the point - what may be the right decision in one patient may be completely wrong for another patient and there is no substitute for a frank discussion and examination with an experienced plastic surgeon when a patient is researching her options.  In your case, because you want upper pole fullness, I would seriously consider a lift with a below the muscle implant.

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon
4.9 out of 5 stars 293 reviews

Should I Get a BA with Implant in Front of Muscle to Improve Droopiness or Should I Get a BA Behind the Muscle with Mastopexy?

Dear Twinmommy,

Thank you for your question.  You would need to post standardized photos for us to make specific comments on you.  However, the best thing to do is look at all of the results from those 5 surgeons with your type of breasts.  Choose the results you like best.

best wishes, 

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Implant location in breast augmentation

the answer to your question is not at simple as one might think.  will position infront or behind the muscle does play a role in the correction of drooping, there are also many other factors.  these include amoung of droop, size prior to augmentation, and implant size to name a few.  traditionally a dual plane augmentation where dissection is carried out above and below the muscle and the implant is placed below the muscle is touted to be the best method to correct drooping.  when feasable placing it just below the breast is also helpful. if there is a fair amount of droop and the implant is place under the muscle without the dual plane dissection, drooping may not be corrected.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 57 reviews

Breast augmentation versus breast lift

Dear twinmommi2boys, I face that very question from my patients a few times a week.  There are patients that clearly need a lift and patients that clearly don't and then there is this group of patients that sit right on the fence where the decission is hard to make.  The best way for me to decide is to look at the patient's profile photo.  If the nipple is pointing down then they will need a lift.  If it's pointing straight ahead then they won't.  The old school way to avoid a lift is to do an augmentation in front of the muscle with a large implant which provides for a very short lived solution, typically these patients will find themselves sagging even worse in the short term (3 to 4 months) not to mention the higher rate of capsular contraction with retro glandular implants and the uncomfortable feeling of being larger than you wanted to be in the firs place.  If your goal is just to look good with your clothes on and depend on a bra for support then the augmentation is a reasonable option.  If what you want is to improve your shape even without a bra and achieve that upper fullness then your choice should be a lift with the implants under the muscle... DrBrou

Juan A. Brou, MD
Oklahoma City Plastic Surgeon
4.7 out of 5 stars 36 reviews

Will breast augmentation above the muscle fix my droop?

I always tell patients to get the best breast augmentation possible and lift the breast up onto it.  It's difficult to tell without an exam whether the implant will elevate your breast enough to not need the lift.  If there is doubt, you can always stage the procedure. You have done your research and seen several plastic surgeons.  I would suggest going with the one you trust as I think some people talk patients out of the lift because they are afraid they won't schedule the augmentation due to cost, scars, etc. Unfortunately, if you need a lift, you need it! 

Brian Dorner, MD
Columbus Plastic Surgeon
4.6 out of 5 stars 20 reviews

Augmentation approach

good afternoon!


as you can imagine it is difficult to say without an exam but I will offer this:

While it is nice to be able to have an augmentation without extra mastopexy scars- trying to solve the droopy problem with a larger implant over the muscle does have its tradeoffs.  The most important thing to realize is that bigger implants are heavier, and heavier implants will sag sooner- there is no getting around gravity's effect on heavier objects.  Also in many patients with this issue there is less tissue available to help use as a support for your implant when it is placed above the muscle vs below the muscle- a fact that can also lead to earlier sagging.

Again so much of this depends upon your tissues characteristics and the amount of ptosis you have.  I would discuss these tradeoffs with your prospective surgeons before making a decision.

good luck

I hope this helps

Robert Steely, MD, FACS
Houston Plastic Surgeon
4.8 out of 5 stars 55 reviews

You should try 5th generation mastopexy augmentation with anatomical or tear drop shape

this fantastic modern technique  has many  advantages over another breasts lift augmentation a.- do not  fall down again b.- any viscible scar except on upper areola tissues d.-do not  affect sensibility  and  future lactancy e.- the most important prevent breasts  cancer

Ramon Navarro, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast augmentation and lift

Hi Twinmommi.

It depends on what your breasts look like and the quality of your tissue. If you have enough tissue in the upper poles of your breasts, good skin quality and nipples that are not too low you might be able to get a good result with implants above the muscle. It is an easier procedure than the augmentation/mastopexy and, in general, it causes less discomfort since the muscle isn't cut and stretched. That being said, most plastic surgeons like myself prefer to place implants under the muscle. The right size implant might be enough to lift your nipples to a position that you might be happy with. With a more conservative size implant you would be more likely to benefit from the addition of the mastopexy. I find that patients usually start off very worried about what their scars might look like, but very few patients complain about their lift scars after the surgery is over. The fact is that the lift allows us to get a very pretty breast shape and most patients will accept the trade-off of some fine scars for the  big improvement in breast shape that the lift gives them. Good luck.

Justin West, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 28 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.