Do breast implants look bigger if they are over the muscle?

Question

Do breast implants look bigger if they are placed over the muscle than under the muscle?  Is there a specific breast shape look better if the implants are placed over the muscle?  Does placing the implants over the muscle increase the risk of making the breast saggy?

Pejman Aflaki, MD · Answer

Hello
and thank you for your question. There are advantages
and disadvantages to each technique and there is no one right answer that can
be given. Generally speaking, submuscular placement of the implant is
associated with less risk of capsular contracture, more natural upper pole
slope and less rippling/implant visibility. As there is a layer of muscle
separating the implant from the breast tissue, there will also be less interference
with mammograms. I would discuss all of these
with a board-certified plastic surgeon prior to making your final
decision. 
Best
wishes and good luck,
Pejman
Aflaki, M.D. Johns Hopkins-trained double board-certified plastic surgeon

Joshua Cooper, MD, FACS · Answer

Breast implants placed on top of the muscle (subglandular) tend to look less natural than implants placed under the muscle. Think of placing implants on top of the muscle vs. under the muscle as if you were to place something under a sheet vs. a blanket. The three reasons I usually place implants under the muscle: appears more natural, less likelihood for capsular contracture, and perhaps less likelihood to interfere with mammograms. Definitely discuss your concerns and questions in person with a board certified (ASPS Member) plastic surgeon.

Kenneth Hughes, MD · Answer

It is not unreasonable to increase the size by about 10% due to compressive forces if breasts implants are not placed over the muscle.  Submuscular is a better choice for a number of reasons including reduced risk of capsular contracture, better longevity, and greater implant coverage. Very few breast augmentation patients have enough breast tissue to permit a subglandular augmentation

Gary M. Horndeski, MD · Answer

Unfortunately, you have not told us your bra size or provided photographs.  Implants are not lifetime devices and bigger implants are more unstable.  The only thing holding up the implant is the skin envelope and 30% are removed by 6 years.  Shaped implants are textured and have been associated with BIA-ALCL.  I would need more information to give you a more accurate answer.  If you want to look bigger you may need a breast lift with implants.Best Wishes,Gary Horndeski, M.D.

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Farbod Esmailian, MD · Answer

There are two positions for breast implant placement:  subglandular vs submuscular.  Subglandular:  was popular in the early stages of breast augmentation surgery and majority were placed in front of the muscle back in the 70s and part of 80s.  We have found out now that placing implants in front of the muscle is not a good procedure.  The risks definitely outweigh the benefits.  The benefits are slim and include less pain, faster recovery and no animation deformity (implants dont distort when you flex your pec muscle).  The risks are many and include: higher capsular contracture rate, rippling, premature sagging, implant palpability.Submuscular:  usually not entirely behind the muscle but more of a dual plane.  The inferior part of the implant is behind the breast tissue and the upper part (2/3) is behind the muscle.  There is less implant visibility, the implant is more camouflaged especially in the upper pole, less risk of capsular contracture, less risk of rippling.I would make certain your surgeon is a board certified plastic surgeon and make sure you see plenty of before and after photos.Hope that helps.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.   Breast implants do not physically change size in relation to placement above or below the muscle.  There are several advantages and disadvantages to over vs under the muscle.  Under the muscle has the advantage of lower capsular contracture rates, less risk of rippling, and better visualization with future mammograms.  Most patients say that under the muscle also has a more natural look and feel.  The size, shape, and profile of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
 
 Best wishes and good luck.

Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon

Daniel Barrett, MD · Answer

Dear natnat111111,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Over time, the size will be about the same for under and over the muscle, however, under the muscle avoids the edge look and has less rippling and sagging. If you have minimal tissue or need a lift, placing the implants behind the muscle will give a better long term look.

Scott E. Kasden, MD, FACS · Answer

Hi natnat.You ask some interesting questions which I'll try to answer.Implants over the muscle may look larger (slightly) compared to under the muscle, comparing the same implant.  However, over time, I'm not sure that is maintained.  The most important thing in implant sizing is matching the diameter of the implant to the hemithorax.  The projection can then be adjusted to the needs of the patient.I think a breast implant can be placed above or below the muscle in all breast shapes.Generally speaking, I prefer the under the muscle position because the muscle acts like an internal bra and over time, they help reduce sagging.  Additionally, there is more tissue above the implant so you are less likely to see/notice the implant, have a lower capsular contracture rate, and have (at least theoretically) more protection for the implant.Hope this helps.sek

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Do breast implants look bigger if they are over the muscle?

Answers (15)

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