Why aren't there many Breast lifts w/ implants over the muscle? Under the muscle looks deformed

Question

Most under the muscle lift w/ implants look high on the top and droop on the lower part. The best way I can describe this is it looks like snoopy's nose or mr. snuffleufagus. It looks as though the breast is folded over so they end up looking like bigger, saggy breasts. Can anyone explain this & why MOST lifts w/ implants look this way? Desperately seeking a surgeon who shares this outlook in Fort Lauderdale FL to do my breast lift + silicone implants. TIA!

Daniel Barrett, MD · Answer

Dear kay55555,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

Placing implants under the muscle should not preclude the ability to achieve an attractive natural appearance to the breasts. Look at photos posted by surgeons to find one who's aesthetic outcomes are similar to your goals. There are definite advantages to going under the muscle and this should be discussed during your consultation.

Robert M. Lowen, MD · Answer

No, it's just because they weren't done properly.  You can find a myriad of pictures online and in the aesthetic surgery literature of beautiful breast augmentation lifts, so obviously, whoever did the ones whose pictures you don't like, didn't do them right.
   Planning nipple position is a bit tricky, and if it is too low, and the implant is a bit too big, everything is working in the wrong direction to create just what you find objectionable. 
   Proper size implant, centered on the  breast footprint, not too big and wide, nipple position where it will sit at the apex of the breast curve, and proper measurement and removal of just enough skin to allow the implant to sit in a relaxed curve of skin, give a nice result.
   If you want to have this operation, just find a plastic surgeon that can show you some results you like and you are more likely to have a similar outcome.
   There are principles in tailoring the breast/skin envelope in mastopexy that can be learned, and our plastic surgery meetings have courses taught  by experts that can help every plastic surgeon get good results.

Gary M. Horndeski, MD · Answer

When implants are placed over the muscle, it often devascularizes the main blood supply to the nipple-areola complex. Also, during a lift, it can devascularize the blood supply to the nipple-areola complex. The two together can lead to complication such as nipple necrosis. Placing the implants under the muscle is a safe procedure in that regard. Unfortunately, you have not provided photographs or told us your bra size. However, the breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ashley Thorburn, MD · Answer

The choice between over-the-muscle (subglandular) and under-the-muscle (submuscular) breast implants in combination with a breast lift depends on factors like individual anatomy, desired outcome, and surgeon recommendation. Each approach has its pros and cons. Under-the-muscle placement is often preferred for a more natural look and reduced risk of complications, but individual results may vary. It’s crucial to consult with a skilled plastic surgeon to discuss your specific goals and determine the best approach for your case.

Connie Hiers, MD, FACS · Answer

Most place the implants behind the muscle to give more support to the implant and more upper breast fullness. Women with sagging breasts need more upper breast fullness. Sagging tissue does not support more weight well even if moved and tightened. The muscle is not sagging, does not sag, and can help support the weight of the implant. If tissue is still sagging, not enough skin was removed.

Shana Kalaria, MD · Answer

A breast augmentation mastopexy (implants with a lift) should have a natural shape and in most cases an anchor pattern scar. The implant should fall naturally into the pocket and round out the breast. If the implant stays too high and the breast gland falls low, you get this snoopy shape deformity. It is a complication and should be revised. Please visit with a board-certified plastic surgeon with experience in this surgery. Good luck!

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  A properly done breast lift with implant placed under the muscle should look excellent and normal.

In my opinion doing a breast lift and placing in implant on top of the muscle at the same procedure causes an increased risk of loss of a areola or nipple tissue due to interference with circulation or blood flow to the nipple areola caused by pressure from the implant against the undersurface of the breast.

At this is just my simple opinion and not based on any available plastic surgery literature, therefore it is simply a guess on my part.

Why aren't there many Breast lifts w/ implants over the muscle? Under the muscle looks deformed

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