One doctor wants to do breast aug. above the muscle & one beneath. Which is right for me? (photo)

I've had consults w/ 2 highly recommended docs in my area. I'm 31 years old. I have three children ages 5, 3, and 15 months. I'm 5 feet 5 inches tall and 128 pounds. I'm very active. I do crossfit and Olympic lifting four to six days a week.

Doctor Answers 18

Implant Placement


Thank you for your question. There could be a few different factors influencing the specific recommendations for you such as your physical measurements and breast tissue thickness. As well, your level of activity and fitness. When a patient is thin with little of their own breast tissue or fat available to camouflage the upper pole of the implant I will likely advise submuscular placement as this will provide the most natural appearance. You should discuss all of the considerations and your expectations in person. Perhaps book a third consultation.

All the best

Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Breast Aug

Thank you for the photo and question.  As always a personal consultation and physical exam are best to determine what surgical approach is right for you.  In looking at your photo I would recommend a submuscular augmentation as you have thinner skin and I feel this will give you a better result both short and long term.  I operate on a lot of athletes and crossfitters and they do well with under the muscle implants.
Best wishes!

Jamie Moenster, DO
Tucson Plastic Surgeon
5.0 out of 5 stars 38 reviews

Breast Augmentation: Information

Dear Ms. Maggieeeeee,

Thank you for your story, questions and photos.

Nothing substitutes for a personal evaluation and a face to face discussion of your options. Many factors need to be taken into consideration than just your desired breast volume. Unfortunately without a exam of your tissue and measurements I will try to answer your question and provide can you additional general information that I hope you find helpful.

There are many decisions both you and your Plastic Surgeon needs to make.
Based on your photos, my answer to your specfic questions are:
1) I in general prefer that implants be placed under the muscle (dual plane) because of the lower incidence of capsular contracture and the coverage the muscle provides.
2)I would advise round silicone gel filled implants (the profile to be determined by your chest measurements: see below)
3)Volume size to be determined as described below
4)the inframammarry incision is associated with lowest rate of post operative capsular contracture.
5) At your preop appt. and on the day of surgery bring several model photos of what you want your final breast appearance to look like
Your final decision should be based on personal consult with a Bd. Cert. Plastic Surgeon who will examine you and go over that which is best for you. The following are some of the topics you may want to discuss and why.

General overview of your choices and discussion points:
1) normal saline fill vs silicone gel fill
2) profile: low profile to high profile (choice based on chest measurements)
3) shape: form stable vs round

1) sub pectoral, dual plane
+ less chance for internal scarring (capsular contracture)
+ padding from the muscle therefore less chance of implant palpability (rippling)
- varying degree of animation upon pectorals major contraction ( breasts moving)
- longer immediate recovery
2) supra pectoral
+ in borderline ptosis (breast sag) can provide alternative need for mastopexy
+ faster immediate recovery
- increase chance of internal scarring (capsular contracture
- increase potential for breast implant palpability (rippling)

1) periarolar
2) inframammary
3) axillary

1) symmetrical
2) equal size
3) breast fold location

1) normal
2) high
3) low
4) symmetrical
5) too large

1) stretch marks
2) thin skin
3) elasticity

is a very personal choice
1)implants come in "cc" sizes not cup sizes
2) 30 cc = 1 ounce
3) purchase a full bodied, non padded bra and take a nylon stocking and fill until you reach the desired size you desire....measure the volume using a measuring cup and convert to cc's.
4) If implants placed under the muscle I personally recommend add 10% to measured volume to compensate for the flattening affect of the subpectoral placement

I personally choose the company that the breast implant base measurements and match to the patients chest measurements. Sientra only makes Silicone Gel filled implants. Ideal only makes Normal Saline implants (with internal baffles). Allergan and Mentor make both silicone gel and Normal Saline filled implants.

Please bring several model photos of your desired breast appearance and a list of questions to your consultative appointment and make sure your Plastic Surgeon is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and
a focus on Cosmetic Plastic Surgery).

Best wishes,

Dr. R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Robert A. Hardesty, MD, FACS
Riverside Plastic Surgeon
4.9 out of 5 stars 100 reviews

Implant Positioning

Implants placed under the pectorals muscle look and feel better and have fewer complications then implants placed over the muscle. However, placing implants under the muscle might decrease your strength or decrease your ability to participate in those sports. 
Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

One doctor wants to do breast aug. above the muscle & one beneath. Which is right for me?

Breast augmentation under the muscle will create more camouflage with more natural transitions, less rippling, and a smaller risk for capsular contracture.  Find a board certified plastic surgeon who has performed thousands of these procedures and has hundreds of pictures and reviews.

Kenneth Hughes, MD

Beverly Hills, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Breast Implants Above or Below the Muscle?

While there is a lot of controversy about whether an implant should go above or below the muscle and many surgeons have strong feelings, what it comes down to is reducing complications. The main complication that surgeons are trying to avoid is capsule contracture or hardening of your implants. This has been reported as high as 20% in some studies and smooth implants have a rate that is between 8 and 20% depending upon the medical study you read. Textured Sientra implants have about a 2% capsule contracture rate and the 9-year data that has not been formally reported looks like it might be even better than that. These implants can be placed above or below the muscle.

Another problem with implants is animation or window shading of the implants. This happens with implants placed below the muscle and is the reason why most body builder over the years have elected to have their implants placed above the muscle.

To avoid both of these problems, you might consider Sientra textured implants placed above the muscle. I would also recommend a 24-hour rapid recovery protocol to help reduce complications and get you back to working out within a week of your breast augmentation.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 reviews

Above or below the muscle?


Thanks for your question. The short answer is probably that they are both right.
There are pros and cons to all planes used in breast augmentation.
Over the muscle means that you are less likely to see the breasts move when you are performing all your fitness activities but the edge of the implant may be visible and you may see ripples as you are quite thin on the upper part of your breast.

below the muscle or dual plane will cover the upper part of the implant better but you may see the breasts move when exercising.

Best of Luck

Gerard Lambe, MD
Manchester Plastic Surgeon
5.0 out of 5 stars 16 reviews

Breast augmentation

I would put the breast implants under the muscle but perform what is called a dual plane augmentation.  This will give benefits of both under muscle (padding) and over muscle (nipple elevation). If the implants are placed OVER the muscle there is a higher chance of rippling and capsular contracture.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 46 reviews

Placement of implants

Based on your photo I would recommend placing your implants under the muscle because I  think you will get a better result with this approach.  An examination and "in-person" evaluation with a board certified plastic surgeon will give you the most accurate information.

Vanessa Voge, MD
Wichita Plastic Surgeon
4.6 out of 5 stars 10 reviews

One doctor wants to do breast aug. above the muscle & one beneath. Which is right for me? (photo)

Hi and thanks for your question. You appear to be a good candidate for sub muscular breast augmentation. It doesn't look like you have much glandular tissue so implants placed above the muscle would look visible and not natural in appearance. 

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.8 out of 5 stars 23 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.