Getting 450cc overs and haven't met anyone with over the muscle implants as of yet. Any suggestions?

Really excited for my op on the 20th August! Haven't had my pre assessment yet, but wondering why my surgeon told me to have over the muscle implants, haven't met anyone with these yet, and have also read a few negative comments on here about them. I am 5ft 6 and 70 kg, currently a 34 C looking to go to an E. Any comments appreciated.

Doctor Answers 5

Breast implant placement

Hi and thanks for the question.

For a primary breast augmentation, implant placement will largely be dependent on your surgeon's preference, which will be based on his/her experience and training. In Beverly Hills, most surgeons are performing dual plane breast augmentations. There are a few surgeons, however, who prefer a sub-glandular approach.

Best of luck.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 29 reviews

Under every time

There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular.  This can be best accomplished with the armpit approach. The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.

Implant Placement

The best placement for optimal results can depend on a few different factors. For many primary breast augmentations, implant placement part way under the muscle can help to camouflage and minimize rippling, however if you have significant breast tissue and fat in the upper poles of your breasts and if there is some deflation or minor sagging present- implants placed in the sub mammary position can give a perkier, more lifted look. As well, for Tuberous breast correction, where constricted tissue has been released, implants will often be placed over the muscle.
Your Plastic Surgeon would have examined you and made recommendations based on your anatomy and your needs. I recommend that you discuss further with them so that you can understand your recommendations and ensure you choose what will give you optimal results.
All the best

Over or Under the muscle?

Thank you for your question.

The decision to go with over the muscle implant placement truly depends on your surgeon’s assessment, and this can be based on multiple factors.

Without an in-person exam and pictures, I cannot really tell you why this decision was made. Perhaps, the surgeon suggested that based on your goals and desires.

Open communication with your surgeon is important to get the reasons. Remember, you should never make decisions without understanding their consequences.

That being said, I can provide you with advantages and disadvantages of the over the muscle and under the muscle implant placement.

Firstly, the decision to go behind the muscle or over the muscle has to do with the amount of soft tissue coverage – “padding” under the skin. Choosing a pocket that is tight with sufficient soft tissue coverage not only prevents implant visibility, palpability, and risks of excessive stretching on the breast, but also excessive implant movement into the outer or inner sides of the breasts. A hand-in-glove fit for the implant allows for a natural and long-lasting result. Your surgeon will do a pinch test in the upper pole of the breast to see how much “padding” you have. If you have less than 2 cm, then you do not have much padding and it would be best to go under the muscle. Generally speaking, if your ribs are visible under the muscle, then you do not have much “padding.” If however, you have more than 2 cm of tissue, then you have the option to go over the muscle or under the muscle.


If you are hoping to fully preserve the functionality of the pectoralis major muscle due to athletics or body building, or if you have a shapeless, constricted, tuberous, sagging breasts without cleavage, then over the muscle may be a better option.
  • Over the muscle implant placement causes less trauma to the chest muscles, and the implants will not be subjected to any pressure or injury due to muscle movement.
  • The implant can directly apply pressure on breast tissue to shape the breasts.
  • However, over the muscle implant placement may have higher risks of breast tissue wasting, interference with mammography, and capsular contracture compared to under the muscle placement.
  • Higher risk of implant visibility and palpability is possible if you are thin, and this can be fixed used fat grafting where areas with less tissue coverage are filled with your own fat to provide better contour and coverage.


Under the muscle (partially submuscular) is a preferred option for many surgeons because the muscle helps to maintain a slope for the upper pole while allowing for a curvature in the lower pole, while over the muscle will mostly make your breasts appear round and augmented.
  • In thin patients, additional coverage by the muscle reduces the risk of implant visibility in the upper and inner sides of the breasts. It also reduces risk of synmastia, and provides less interference with mammography and breast imaging. It also brings lower rates of capsular contracture.
  • However, under the muscle implant placement may allow the chest muscles to put pressure on the implant distorting the breast shape and position in the long-term. You may experience more pain following surgery due to the dissection of some muscle attachments and you may lose strength while flexing your chest muscle and is not suitable for athletes and body builders.

It is important that you communicate your goals very clearly, but understand that you need to have realistic expectations.

Hope this helps, and best of luck!

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 414 reviews

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

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



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.