With Breast Implants, What Placement Is Best For Me? What Could Cause Rupture?

I'm 18, 5'1", 112 lbs. I'm naturally a B cup and I'm considering saline breast implants to become a D cup. Should I go for under or over the muscle and would it cause the chances of the implant to rupture more one way?

Doctor Answers 12

Breast Implants Best Placement-under muscle or over breast?

If possible placing breast implants under the muscle provides thicker coverage of the implant and a more natureal. This is particularly important for saline implants because they tend to form ripples with time and there is a better chance of hiding the ripples under the muscle. However if your breasts are sagging, under the muscle may cause a snoopy deformity.

Rupture rate for saline or deflation rate is the same under or over the muscle.

Cup size is hard to predict. Check the link below for information on how to choose breast implant size. The Rice test is the best

Breast Implant Positioning and Rupture?

Thank you for the question.

I think there are many advantages of placing breast implants and the “sub muscular” ( dual plane) position.

Although breast implants in the sub muscular ( or dual plane)  position may experience “distortion” with muscle movement (workout) 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.

You will find that there is no difference  In leakage/rupture rates with implants placed above or below the pectoralis muscle.

In regards to achieving your desired results after breast augmentation surgery, it will be very important to communicate your size goals with your surgeon.  in my practice I find the use of goal pictures to be very helpful.   I have found that the use of words such as “natural” or “D cup” etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. Placing breast implants on top of the skin ( pre-operative “sizing”) is not necessarily accurate either.

I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Saline submuscular implants

The submuscular placement has many advantages such as a lower capsular contracture rate, and better coverage with less thinning and implant show over time. Implant rupture rates will not be affected by the pocket location.

Best of luck, peterejohnsonmd.com

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

Breast implants will probably achieve your goals

If you are presently a B cup and want to be a D cup, then breast implants will most likely help you achieve your goals.  I suggest either saline or silicone implants, placed underneath the muscle.  With your height and weight, I would recommend implants in the order of 390 to 420 cc's would probably be about the right size to achieve your goals.

James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Saline breast implants should go under the muscle

As an 18 year old, your breast implant choice is limited to saline.  Those are the rules based on the FDA approving breast implants.  At 22 years of age, one can chose between saline and silicone.  Saline implants don't look or feel very good on top of the muscle.  They often show ripples and wrinkles.  I strongly recommend submuscular implants for you.

Daryl K. Hoffman, MD
San Jose Plastic Surgeon
4.6 out of 5 stars 16 reviews

Subglandular v. Submuscular Implants

There is no data that shows that the plane in which implants are placed makes a difference in rupture rate.  It does make a difference in the way the implants look and feel  In a thin woman, like yourself , an under the muscle inplant gives more coverage to the implant and thus appears more natural.  You are still too young for mammograms, but when you are at the recommended age for breast screeniong, an under the muscle  (dual plane placement) allows for better reading of the test.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 114 reviews

No good reason to put implants on top of the muscle

Thank you for your question. There is no difference in rupture rates under the muscle vs on top of the muscle. There are a variety of problems with implants on top of the muscle including a less natural feel, less natural appearance unless you have a lot to cover up the implant, more rippling, a higher risk of capsular contracture and they get in the way more when getting a mammogram. You are very petite based on your height and weight. A D cup is probably rather large for your body type and I doubt that it would look very natural. Make sure that you see a board certified plastic surgeon.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Implant size and rupture

Picking implant size depends on your breast dimensions, size, breast tissue and shape. The size cannot be promised since it depends on which bra you wear (I.e. A "D" in one brand may be a "C" in another brand- much like dresses or shoes). There are advantages to placing the implants under the muscle. Placement of the implants does not influence rupture rates. Saline implants usually deflate from either fold failure or problems with the fill valve.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Breast implants

If you are very tin and do not have a lot of soft tissue coverage, I usually prefer to place the implants under the muscle.  It provides more upper pole coverage.

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

Implant Rupture Rates not affected by pocket location

Hi there- 

While there can be no doubt that there are many advantages to the average woman of placing her implants under her chest muscle, lowering the risk of rupture is not one of them.

Remember also that the decisions you make now will affect your life in many ways in the future- larger implants will cause your breasts to sag more than they would if they were more appropriate for your body, requiring more operations over your lifetime, with more expense, and more scarring.

I would advise you to think about your options very carefully and be sure that you are maximizing your safety, and your chances of being happy with the decisions you make both now and in the future.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 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.