How do you determine whether to get overs or under the muscle? (Photo)

I'm into weight lifting and have a small frame. I'm 5'3 and between 125-130lbs. I want them to look as natural as possible. I've breastfed 5 children and am currently in a 34B. I'd like to be a full C or D. My breast tissue is very squishy and lack the fullness I once had,

Doctor Answers 25

Under the muscle will look more natural

This is a  very common question.  I place all breast implants under the muscle.  The muscle camouflages the upper pole of the breast implant which makes the breast look more natural with a nice gentle slope.  Over time implants on top of the muscle can become visible with rippling.  This happens more often in thin patients with larger implants.  When the implant is underneath the muscle this just doesn't happen.  Going under the muscle can make it easier for mammograms because the implant can be pushed up underneath the muscle and there is some evidence to support that implants under the muscle are less likely to develop capsular contractors, or scar tissue, around them.  Under the muscle doesn't mean total sub muscular coverage.  You can have the benefits of under the muscle by going with a "dual plane" approach.  This means the upper 1/3 to 1/2 of the implant is underneath the muscle.  The lower portion is within the breast gland.  This gives the nicest look with the benefits of going under the muscle.  Discuss your concerns with your plastic surgeon.  Best of luck.

Cleveland Plastic Surgeon
4.9 out of 5 stars 107 reviews

Above or below muscle

You should be certain that you are seeing a board certified plastic surgeon with a lot of experience in breast surgery. My preference is to place implants under the pectoral muscles most of the time. The exception may be in a body builder because the muscles may be too big. The other consideration may be the possibility of needing a lift as well. In that case, I definitely prefer under muscle.

William H. Gorman, MD
Austin Plastic Surgeon
3.9 out of 5 stars 18 reviews

Split muscle placement is often appropriate for athletic women seeking #breastaugmentation.

Hello & thank you for your excellent question.

For women with muscular, or athletic builds, I use the split muscle technique. This means that the upper portion of the implant is placed under the muscle, while the lower portion rests on top of the muscle. Thus, I do not have to cut the muscle’s attachment to the chest. Not only does this minimize the chance of animation deformity, but it avoids sacrificing muscle strength as well.


This technique can also lead to more natural-looking implants on smaller frames. For some women, implants placed the traditional way (totally over or under the muscle) may appear to be much rounder than a natural breast.


With the split-muscle technique, however, only the upper portion of the implant is placed under the chest muscle. The muscle then pushes down on the top of the implant, producing a more natural teardrop shape while promoting projection and perkiness.

Because of these benefits, splitting the muscle can make natural-looking breast implants a reality for women with smaller, athletic builds.

Over or unders with weightlifting

While the coverage of potential wrinkling is always better under the muscle, the animation deformity that you might see in a weightlifter can be avoided with a placement of the implant on top of the  muscle. There may be a slightly higher capsular contracture rate in this position. I would consult with a few board-certified plastic surgeons with experience in cosmetic breast surgery to learn about your options.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

Weight lifting and position of breast implants

   In competitive weight lifting, it seems that most women have the implants placed on top of the muscle under the breast(sub-glandular). If you are into competition, I would recommend looking into this angle further.  I advocate having the implants placed under the muscle as this position causes minimal or no interference with mammogram interpretation.  That cannot be said for the sub-glandular position.  Discuss with your plastic surgeon and good luck. 

John Zavell, MD, FACS
Toledo Plastic Surgeon
4.9 out of 5 stars 34 reviews

Under the muscle or over the muscle?

This a question that many patients ask.  If you have sufficient native breast tissue, you can easily have implants placed above the muscle with excellent results.  I usually advocate this approach in women who are avid weight lifters to avoid animation displacement of the implants from the action of the pectorialis muscles.  Depending on the degree of skin laxity and the size of the implants, a small mastopexy may be needed to tighten the skin envelope to match the underlying implants.  This approach has the advantage of an easier recovery but slightly higher risk of capsular contracture over time. Good luck.  I suggest a consultation with a board certified plastic surgeon.  

Brian A. Pinsky, MD
Long Island Plastic Surgeon

Above or below the muscle

Thank you for your question.  Implant pocket location choice depends on implant type and volume, amount of native upper pole breast tissue, and patient goals as already discussed by the other surgeon responses.  Consult with one or more board certified plastic surgeons certified by the American Board of Plastic Surgery to discuss your options.  

Breast implants over or under

Weight lifters are usually better with implants over the muscle- higher filled gel Sientra or Natrelle Inspira are good choices.

An exam and consultation with a plastic surgeon who uses these implants  is recommended to confirm you are a candidate as well as discuss your options and expectations. 

How do you determine whether to get overs or under the muscle?

You need to get 2-3 consultations with experienced surgeons for an exam and determination of your goals. The surgeons may not all agree on the best course for you but at least you will get a good understanding of the different techniques available so you can make an educated choice. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Implant pocket

I prefer in the majority of women to place them under the  muscle.  I think it offers more soft tissue coverage in the upper pole and also may decrease the risk of a capsular contracture.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 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.