550cc Implants Should I Go Above or Below the Muscle? (photo)

I'm 42 years old 5' 11" and 245lbs my breast augmentation is two weeks. what would give me te best look.

Doctor Answers 9

Augmentation over or under the muscle

continues to be debated fiercely by proponents in each camp.  My own experience suggests under the muscle may provide a longer, better results and avoid the 'rock in a sock' look as you get older.  I prefer the dual plane technique for the following reasons.

1) more fullness in the upper pole with a more natural slope from chest wall to breast

2) avoid visible rippling  in the upper pole since its covered by muscle

3) better mammograms under the muscle

4) and most importantly, less risk for contractures under the muscle.

The only 'con' about going under the muscle is that your breast will move/contract when you contract your chest muscles and I advise my patients they are not longer to participate in strengthening activities for their chest muscles.  I was once associated with another doctor that advocated going above the muscle.  The community consensus favors under the muscle.

Redding Plastic Surgeon
5.0 out of 5 stars 25 reviews

Silicone implants and the width/projection of the implant will be most important decision


Thank you for the photos.  If you are considering having an implant placed on top of the muscle I would encourage you strongly to only consider silicone.  For that size implant even if you place the implant under the muscle an appreciable percentage of the implant will be below the lower border of the muscle and therefore not under the muscle (dual plane).  Make sure your plastic surgeon selects the proper implant width and projection based on your body and goals.  After that, it will really not make much of a difference between under or over the muscle.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 133 reviews

Implant placement

I'm sure you've read about the above the muscle (subglandular) and under the muscle technique.  I generally prefer the dual plane technique where the upper two thirds of your implant is under the muscle and the lower third of your implant is actually above the muscle.  The dual plane technique in conjuction with selecting the proper implant for your chest wall measurements (dimensional planning) helps me to acheive a natural shape in many different body types.  I hope this is helpful for you.

Dr. Basu

Houston, TX

Submuscular vs. Subglandular Breast Implant Position?

Thank you for the question.
There are pros and cons to the placement of breast implants and the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.  Also, the immediate recovery period may be  more comfortable  after sub glandular breast augmentation as compared to sub muscular breast augmentation surgery.

Best wishes with your upcoming surgery.

Implants above or below muscle

At least based on your photos, you do not look like you have a lot of breast tissue.  I usually prefer under the muscle for most cases as it offers more soft tissue coverage.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Best look for breast augmentation

There is indeed a place for both uver and under the muscle positioning in breast augmentation, however submuscular will give a nice lasting shape, and reduce an upper round look with a full implant. The capsular contracture rate is lower as well. Given the photo submited our vote is for under the muscle.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 37 reviews

Breast augmentation with 550cc implant

Thank you for your pix. You are a good candidate for breast augmentation. Two considerations:

1.  Placing the implants under the muscle in you is very important to provide a more natural look and coverage of the implant. 

2.  Placing the implant through your areola would be difficult, hence your fold under the breast needs to be planned very carefully to place the scar in your new to be fold. 

Please see a board certified plastic surgeon with expertise in this area. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 70 reviews

Placement of 550 cc implants

I would recommend placing implants of that volume under the muscle both for tissue coverage and for a more natural appearance. The implants are quite large and my concern is whether you can accommodate that size implant at an primary augmentation.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

Implant placement

Thank you for the pictures.  I always recommend my patients have the implants placed under the muscle.  This will provide extra tissue coverage over the implant and allows for a more natural appearance.  Also, in skinny patients such as yourself, you always want to go under the muscle to decrease the chances of being able to feel the implant through theskin.  I hope this helps you.

Kindest regards,

Neil J. Zemmel

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.