Open to all over 200cc to 360cc - is it possible to place implant over the muscle? (Photos)

Question

Hi, I would like to ask, what do you think, according to picture I attached, if I am a candidate for implant over the pectoral muscle, is there enough tissue? I do not want a big breast, I am thinking about up to 360cc, but open to all over 200cc. And what do you think about B-Lite Polytech silicone cover implants? I want teardrop shape. Thank you in advance!

Gary M. Horndeski, MD · Answer

Implants placed in front of the muscle often injure the sensor nerves to the nipple. Also, the implant can be more palpable and visible since you appear quite thin. Another alternative to consider is fat transfers to the upper pole of breast initially, around 100 cc's of fat, then come back later with a small implant, if you desire more volume.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Phenomenal200085,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Irena Karanetz, MD · Answer

Hello,
 
Thank you for the question.
 
Based on your photos, you appear to be a great candidate for breast augmentation surgery.  You may be a candidate for subglandular (above the muscle) breast augmentation but it's difficult to answer without in-person examination.
 
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions. 350cc size implant will likely give you a full C cleavage if that is what you desire. 
 
I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon to further discuss your options, specific techniques, concerns and expectations.
 
I hope this helps.
Best regards, Dr. Karanetz
 
Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Ira H. Rex III, MD · Answer

There are a number of things to consider when choosing the position of an implant.  From your photograph it seems you have minimal upper pole tissue to cover the implant, so you might be better served with a nice muscle cushion over the implant to give a natural appearance and avoid any visible upper pole rippling.

Joe Gryskiewicz, MD, FACS · Answer

Hello,
You would be a candidate for placing implants over the muscle. I'd recommend using an implant like has less wrinkles to it and is a cohesive gel such as the Mentor Xtra implants. 
All the best,
Dr. Joe

Marvin F. Shienbaum, MD · Answer

It's absolutely possible to place a breast implant over the muscle. This placement is known as subglandular or over-the-muscle placement.

Here's a breakdown of what that entails:

Placement: The implant is positioned directly behind the breast tissue and in front of the pectoralis major muscle (the chest muscle).
Suitability: This approach can be suitable for individuals who have enough existing breast tissue to provide adequate coverage of the implant, which helps to achieve a more natural look and feel. It's also often preferred by very active individuals as there's less chance of muscle movement affecting the implant's appearance.
Potential Advantages:
Less Invasive: Generally considered a less invasive procedure with potentially shorter recovery times and less post-operative discomfort compared to under-the-muscle placement.
No Muscle Interaction: The implant won't be affected by the movement or contraction of the chest muscles, which can sometimes cause animation deformity (distortion of the breasts during muscle flex).
Potentially More Natural Look: In individuals with sufficient breast tissue, it can create a very natural-looking result.
Good for Active Patients: Implants are less likely to move or distort during physical activity.

Connie Hiers, MD, FACS · Answer

Since you have minimal upper breast fullness, I recommend placing the implants behind the muscle for best upper breast fullness and coverage of the implants. Otherwise, you may see the implant edge.

Mauricio Castano, MD · Answer

Hi, looking at your pics. it's difficult to determine how much tissue you have in the upper pole. If you don't want to have the implant under the muscle, the implant can be placed over the muscle, but we will ned to do fat grafting into the upper pole and cleavage to camouflage the borders, as well to increase the thickness of the tissue (hybrid augmentation).
The size, shape and type of implant will need to be determined just during consultation, as well as the plane of insertion (under or over the muscle). I would go with a dual plane (partial under the muscle) with a small implant (most of my augmentations ranges are from 230-315 ccs). 
Hope this helps for you.

Kamran Khoobehi, MD · Answer

The main concern is the lack of soft tissue coverage of the upper breast. The implants above the muscle will not have tissue to cover it and you will get fake look and rippling of the upper pole. I would recommend highly cohesive Silicone gel implants and fat grafting at the same time.

Kenneth R. Francis, MD, FACS · Answer

Dear Phenomenal,
Yes, if you decide to go over the muscle, a teardrop, or anatomic textured breast implant is your best option.  You should be aware of the advantages and disadvantages of over the muscle breast augmentation, and the concerns specific to textured breast implants.  Either way, above, or under the muscle, you can expect a great result.  Good luck!

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