Breast Augmentation- Under or over the Muscle for Women Who Have Had Children?

I'm 26, have two kids, and am looking to start scheduling my consultations for breast augmentation. I breastfed both my children and my breasts were never large to begin with. I was (and am again) about a full B-small C but of course when my bra is off I look like I could just barely fill a Bcup. When breastfeeding they were a very full D and bigger. I don't have sagging breasts as I don't have a fold, but they clearly have been stretched out... so my question is, under or over the muscle?

Doctor Answers 13

Over or under the muscle implants

In my practice, there are very few people who I feel are better served with implants placed over the muscle. For most patients, implants placed under the muscle will appear more natural, have a lower risk for capsular contracture, have a lower incidence of rippling or palpability, and will be less likely to bottom out over time. 

Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 83 reviews

Breast augmentation pocket

If you are very thin, then under the muscle is probably better. In most patients I prefer under the muscle.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

Breast Implants - Over or Under the Muscle?

Thank you for the question.
In my practice, I would offer you a breast augmentation with the breast implants placed in the sub muscular (dual plane) position. I think the advantages of placing the breast implants in this position are far greater than placing the breast implants in the sub glandular 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) that can be seen with breast 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 1,462 reviews

Over or under question

Hi candace,

thanks for the question. as always, an in person consultation with a board certified PS is best; however, to answer your basic question, as a rule, i always prefer under the muscle implants. There are of course pros and cons to either approach, however, in general, the benefits of an under the muscle implant typically out way any downside. 

if you don't sag, and are not needing a lift, then there is no question, in my opinion, that under the muscle is best. some may argue that over causes more skin filling and lessens the likelihood of needing a lift, but i doubt that is 100% true. the fake look, higher capsular contracture risks are not worth the trouble of an over the muscle implant. hope that answers your question. 

best to you. 

Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 20 reviews

Under is usually still better

When a patient does not have a lot of breast tissue, as in your case, under the muscle is usually better.   This provides more coverage of the implants  and helps to prevent rippling of the implants.   Also more coverage helps them to feel more natural. 

Best regards,

Dr. Lane Smith

Lane Smith, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 90 reviews

Implant location for women who have had children

My preference for women who have had children, breastfed and had significantly larger breasts in the past would be a "dual plane" augmentation, which is actually a combination procedure.  The upper portion of the implant is placed behind the muscle providing camouflage, while the lower portion is placed on top of the muscle, allowing the implant to fill the previously stretched skin. 

The size and style implant selected, based upon your chest wall dimensions and desired post-operative appearance, determine how much your skin will be "filled".  The full extent of your "stretched" skin may not be apparent until surgery, and will generally accommodate an implant giving you a breast size at least as large as you have been in the past (in your case a very full "D" or larger).  If the implant selected is smaller than that, and the implant is placed "under the muscle" you may be left with a "snoopy" appearance to the breast.  Placing the implant on top of the muscle increases the risk that the implant would be visible, and may increase the risk of capsular contracture.

I would recommend scheduling several consultations with board-certified plastic surgeons experienced in breast augmentation, who will take a complete history, perform a physical exam and can make recommendations regarding the most appropriate treatment plan for you.

Good luck.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 28 reviews

Under or over the muscle

You probably have enough tissue to place the implant in either pocket and still get a nice result. I prefer the submuscular pocket as it allows more tissue over the implant to achieve a more natural result especially in a very small breasted woman. The muscle massages the implant with daily activities and we believe keeps the implant feeling soft as well. It also acts as an interface when you go for mammograms for the 75% covered by muscle. That makes it easier for the radiologist.

I believe more plastic surgeons prefer under the muscle as I do. I will place them over when a patient is a body builder, or is trying to avoid an uplift scar.

I would suggest you go online and look at photos and see what you like. Do your research when picking a board certified plastic surgeon as well.

Good luck.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews

Post-partum breast augmentation

The issue of under (subglandular) vs. over the muscle (submuscular) is not a clear right or wrong issue. There are pros and cons to each and these factors and risks should be discussed in full with your plastic surgeon. Many surgeons and patients prefer submuscular while in reality the implant belongs where the breast lives, i.e. subglandular. It is often an issue of safety vs. "naturalness." I prefer to customize the procedure, including the position of the implant, to the individual patient's anatomy, goals, and risk tolerance.

Robin T. W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Under the muscle

Hello. I would recommend under the muscle do to providing better support and reducing the appearance of rippling. The fact that you have had children and breastfed does not affect this decision but may mean that you could benefit from a breast lift as well. I would schedule a consultation for more information.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 74 reviews

Under or over the chest muscle?

Generally speaking, I think most plastic surgeons and patients prefer to place implants under the chest muscle these days if you are a good candidate.  The reason for this is that the extra layer of muscle coverage helps camouflage the implants, especially if you use saline implants which may be prone to more obvious ripples or wrinkles.  Another reason is that there is better blood supply below the muscle and the muscle provides a barrier between the implants and the breast tissue which may harbor bacteria which can increase the risk of infection or capsular contracture (the formation of a thickened scar tissue capsule around an implant which can lead to firmness or distortion of the breast).  Finally, the continuous massaging action of the muscle over the implants helps minimize the risk of capsular contractures as well.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 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.