Which Breast Implant Placement is Least Likely to Cause Sagging?

Which of the following method is less likely to cause sagging of the breast implants, above the muscle or behind the muscle?

Doctor Answers 20

Proper surgical breast implant placement is most important to prevent sagging after breast implants

The truth is that the most common cause of sagging or "bottoming out" of breast implants is that the breast implant pocket has been placed too low. The inframammary crease is a natural landmark and should not be violated during breast implant surgery--if it is, the implant will migrate down.

This can happen with either a submuscular or subglandular breast implant placement.

So, most important for you is to find an experienced board certified plastic surgeon who does a lot of breast surgery-i recommend consulting two doctors.

Another important issue is the strength of your tissues and the amount of breast tissue that you have.

Patients with very little breast tissue and thin skin are more prone to stretchinmg of the skin with time, and in these patients I do recommend the submuscular placement.

Some doctors leave a wide opening at the bottom of the chest muscle through which the implant is placed beneath the muscle-in these cases the implant often sags or is displaced below the muscle-so the advantage of submuscular placement is lost.

Too large implants are more prone to sagging.

The key is finding the best plastic surgeon and specifically ask questions about the above.

A properly placed moderately sized subglandular or submuscular implant in a patient with normal amounts of breast tissue and thick healthy skin should not sag.

Don’t consider sagging to decide Implant Placement.

Sagging in the future is not one of the things to consider when deciding whether to place the implant in front of or behind the muscle. By pushing the breast tissue out, gravity can act more and cause droop no matter where the implant is placed. The resultant look is just slightly different between the two placements. When the implant is placed below the muscle and the breast sags the implant is frequently more obvious since the implant stays up and the breast tissue slides over the implant, giving a “double bubble” appearance. Instead of considering something in the remote future, you are better selecting the placement on more immediate concerns. I personally prefer placement above the muscle for a number of reasons. First, the implant is half out from under the muscle anyway. Secondly, the recovery is much faster (24 hours). Thirdly, if you are at all athletic, the muscle is not disturbed and does not bounce the implant with use of the arm. Fourthly, there is some good evidence that there is less likelihood of implant leakage with the implant above the muscle. The main reasons given for putting the implant under the muscle is to prevent capsular contracture and “rippling.” Rippling is actually a natural phenomenon of the breast from Cooper’s ligaments that connect the skin to the deeper tissues. With at least 2 cm. of tissue superiorly, I have never had a problem with this. If one uses a textured implant above the muscle, the contracture rate is the same as placing a smooth implant below the muscle. Also, if you have any droop presently, it is much easier to correct when the implant is placed over the muscle. I hope this is helpful.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast implant placement location least likely to cause sagging

" Which breast implant placement is least likely to cause sagging?"

All other factors being the same - SUB PECTORAL.

Not to belabor the point or lapse into sarcasm or philosophical musings on the meaning of life and aging, CLEARLY unless we die early, we all age and our tissues weaken and obey gravity's irresistible song and droop. So - without doing anything your breast will thin and droop with age.

How can you help gravity pull your breasts down faster? Long list. Become pregnant a few times, gain and lose weight a few times, do not wear a bra much of the time, smoke, eat poorly, spent time in the sun and tanning booths, have large breast implants put in and fail to support them, among others.

While ALL breast augmentations compromise some of the cables anchoring the breasts to the chest wall (Cooper's ligaments), placing the implant over the muscle divides many more of them. The only thing left to keep your breasts up is your skin (which may or may not be beat up by tanning, smoking etc) and a good support bra which may or may not always be there.

In short - SUB MUSCULAR + wearing a bra.

Good Luck. I hope this was helpful.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 101 reviews

Implant Placement and Breast Lift Options

There is solely no consensus.  #Sagging can occur due to many reasons.  Some include the #size of the breast and implant,  #weight of the breast and implant,  #gravity , #age and/or aging, #weight loss and weight gain.  #Tissue integrity (ie. some women are more prone to experience sagging due to weakness of their skin and breast #tissue at the fold).

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Which Breast Implant Placement is Least Likely to Cause Sagging?

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.

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. Bottoming out is a possibility with either position.  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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Sagging breasts after augmentation

There are ways to prevent bottoming out of breasts (see video) Placing the breast implants behind the muscle can help. But, the size of the implant and placement on the chest wall are also very important.   In my opinion, all breast implants should be placed behind the muscle.  and there are two compelling reasons behind my opinion. First, radiologists have let us know that they can best image breast issue mammographically when an implant is in a subpectoral compared to a submammary position. Another compelling reason is aesthetic. The pectoralis major muscle serves as an additional layer of soft tissue coverage for the upper pole of the implant, and it tends to flatten the upper pole of the implant somewhat creating a very smooth and natural appearing contour to the upper pole.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 113 reviews

"Under the muscle" placement


"Under the pectoral muscle" breast implant placement usually lends more support and retards breast sagging, as long as really large breast implants are not used.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 25 reviews

Breast Sagging After Subglandular and Subpectoral Augmentation

I do believe that the two methods have different long term outcomes. With subglandular augmentation only the breast tissue is utilized to hold the implant in it's proper position. In subpectoral or submuscular augmentation the muscle helps hold the implant in place.

But the reality is that the larger the implant is the more it will thin the overlying breast tissue thus weakening the support mechanism. So larger implants placed under the gland only will result in sooner and greater sagging as compared to submuscular augmentation. Nowadays, most plastic surgeons place the breast implants under the muscle to prevent capsular contracture.

Large implants may lead to sagging

There are many changes that may occur to the breast tissue and skin over an extended period of time. It is the weight of the implant against the breast tissue that causes laxity. When the implant is placed either above or below the muscle gravity, time and weight still exact their toll. The key to having a lasting result is an implant that is appropriately matched to the quality of your skin. If your skin is thin or atrophic then it will sag if the implant selected is too large.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Sagging with implants

I do not think it makes a difference which pocket you place implants in. Most submuscular implants are placed after the muscle is released along the lower border. Therefore the implants are really just subglandular in this position. A breast lift will help with sagging breasts but the pocket will not make a big difference.

Steven Wallach, MD
New York Plastic Surgeon
4.1 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.