Breast Augmentation - over or Under Muscle?

I am 50 years old, 5' 2" around 125 lbs. I have small breasts, B cup, and have decided to have an augmentation. I'm am confused about whether I should have the implants above or below the muscle. I've gotten different opinions from the surgeons I've consulted. I don't need a lift. I would welcome any advice on how to determine which is best for me. I do plan to use memory gel implants, high profile.

Doctor Answers 11

Breast Augmentation - over or Under Muscle?

In general, all augmentations using saline implants need to go under the muscle, to help camouflage the rippling and to give a more natural look. Most silicone gel implants are also placed under the muscle, to give a more natural look (ie, not "two grapefuit halves on your chest"). Having said that, if there is significant breast tissue already present, and you are not going TOO large with your implant, over the muscle may be appropriate. The major issue is the risk of a less natural look if you go over the muscle. The down side of going under the muscle is that your breasts will animate slightly whenever you flex your pectoralis muscle after the surgery. This is typically not a significant issue, but it is one that you should be aware of.

Columbia Plastic Surgeon
4.6 out of 5 stars 21 reviews

Submuscular vs Subglandular Breast Augmentation - which is best?

Since you have no sagging putting implants below the muscle allows for more soft tissue padding, and in many studies less likelihood of experiencing capsular contracture, rippling and especially preferred if you are thin and have little breast tissue to cover the implants and have them appear more natural.

On the other hand if you have a small amount of breast sag, adequate breast volume and do not want a lift a subglandular position may give you a small amount of lift to make it worth it.

The bottom line - pick a good plastic surgeon and ask their advise specific to you.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Breast Implants Under or Over the Pectoralis Muscle?

Thank you for the question.
Although patients who have breast implants placed in the sub muscular ( or dual plane)  position may experience more discomfort during recovery, I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” 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 in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

Above or Below the Muscle

Hello TCinIN,

Assuming each procedure type is performed correctly, implants placed above the muscle exhibit a greater likelihood for more visibility, rippling, and capsular contracture.  These complications are even higher and are joined by excessive tissue stretch and implant malposition when a high profile implant is employed.  These are well known facts and not a matter of opinion.

Although implants placed under the muscle have their own potential drawbacks, they tend to be less severe and less visible, especially to the public eye.

I am sure that you would find this a consensus if you only visit properly credentialed, and highly experienced plastic surgeons. Certified by the ABPS, members of ASAPS.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Most breast implants better under the muscle

There are many decisions to make for breast augmentation, and for women who are thin (as you presumably are) and especially when using high profile implants, under muscle is usually better. The muscle only covers the upper portion of the implant so you may still see some ripples on the side and bottom. Other important decisions are the base width of the breast, which should match the width of the implant, and making sure that the size is what you want.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Breast Implant Placement

Without seeing you in person or seeing pre-op photos, it is impossible to give you specific advice.  However, in most cases, sub-muscular silicone implants give the best results.


Good Luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Breast augmentation

I commonly place implants below the muscle in very thin patients to minimize the risk of rippling superiorly.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Above or Below

In most cases in the United States plastic surgeons place implants, both saline and silicone under the muscle.  This tends to have a lower rate of capsular contracture and gives a more subtle transition in the upper chest where the fullness from the implant ends.  That transition is smoother when the implant is under the muscle.  Those appearance issues are more important in slimmer patients who have less breast tissue. In some cases the choice may have more to do with the personal preference of the surgeon rather than what may work better in a particular situation, which may not be in your best interest.

The profile type of the implant is really a decision best left to a board certified plastic surgeon who should understand the issues of tissue stretch in the short and long term with regard the changes that may occur with different sized implants and implants with differing projections.

If you are confused or unclear as to which way to proceed, I would suggest another consultation with a board certified plastic surgeon in your area. 

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 59 reviews

High profile implants might look best under the muscle

There are many reasons to consider under or over the muscle for breast augmentation. As you have decided on the look of a high profile implant, you have to consider the upper roundness that the implant will produce. Most of us would feel a high profile implant will look better under the muscle.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Above or Under the Muscle? The Logic Behind Breast Implant Placement

We have yet to produce a breast implant which is perfect and does not ripple. ALL breast implant ripple when placed on their side (as they are in your chest).  (This is analogous to what you see when you fill a Zip Lock bag with water and hold it upright).

The ONLY way such rippling can be hidden while the implants are under your breasts is to pick implants which are TOTALLY covered by your present breast tissues. (Which is the reason why although most women can theiretically have very large implants physically placed in their breasts, smaller breasted women do NOT have sufficient breast tissue to cover such implants resulting  in fake, rippled breasts). 

So, over or under the muscle? What size implants have you picked? Are they nicely covered by your breast tissues? Would it better to place them under the muscle (located under the breast) for ADDITIONAL coverage to get a more attractive result?

Good Luck.

Peter A. Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 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.