Do breast implants sag quicker if they're placed over the muscle?

Implant sagging is less a function of implants but rather soft tissue/skin quality. That being said, I do believe a submuscular implant does benefit from greater relative support in the lower pole.

Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Breast implants probably sag similarly whether over or under the muscle. The muscle does not really hold them up. Sagging is often caused by skin quality and other factors. If a patient is going to have sagging breasts, often the implants stay in a good position and the breast tissue sags off of them.

In my professional opinion, placing implants in a subglandular/subfascial position (above the muscle) does not provide anywhere near as adequate support compared to a properly dissected submuscular dual plane pocket.

Dear mfourie51,
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

Yes. When implants are placed under the muscle, the muscle provides some support and thus reduces the tension on the breasts.

Excellent question. Yes and no. An important issue to understand is that implants do not lift the breasts……. Implants fill out the breasts. Plus implants don’t really sag, the breasts sag, and implants actually drop.
The biggest factor for implants sagging or dropping is the size and weight of the implants not the placement. That said, implants that are placed under the muscle usually stay more in place because of the muscle. But it will also depend on what type of under the muscle placement is used. Sometimes implants are placed completely under the muscle and other times they are place in a way that only the upper portion of the implant is under the muscle. Under the muscle placement can lead to bottoming out, breast animation deformity and it can lead to implants not settling and therefore ridding high on the chest wall. These last two complications do not happen with implants that are placed over the muscle.

Implants that are placed over the muscle may “sag“ quicker because there is no muscle holding them up. But sub-facial placement (which is a type of over the muscle placement) uses fascia to help hold on them in place. Over the muscle placements hurt less, post op is easier, settling is faster and the is no risks of implants ridding high on the chest wall or breast implant animation.

Breast sagging can and probably will happen eventually regardless of the implant placement. Breasts with sub-muscular implants tend to sag over the implants. The implants stay in place but the breasts fall over the implants producing the ‘Snoopy Breast Deformity’ or ‘Waterfall Breast Deformity’. This does happen when implants are placed over the muscle. When breasts with implants over the muscle sag, the implants will drop together with the sagging breasts. This reduces upper pole fullness and actually produces a more natural looking breast.

I like both under and over the muscle placement. The choice will ultimately depend on what I feel is the best option for the patient.

Best of luck,
Dr. Mota

Hello!
Yes, implants placed right behind breast tissue can exacerbate sagging. A relatively new technique is called subfascial placement that provides the benefit of some support but is still above the muscle. Implant placed behind muscle historically supports the implant better. Other factors like skin quality and stretch marks as well as implant size and type will impact sagging as well.
Best of luck to you! Be sure to see a board certified plastic surgeon. You can find one at plasticsurgery.org.

Dear mfourie51, thanks for sharing your concerns, this will depend on many factors, like implants size, breast tissue, your skin, and many more, an in person consultation is in need to tell implant position. Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia.

Thank your for your question. Without an examination in person or photos it is impossible to provide you with specific information related to you, but as a rule, in my practice we make every effort to place implants ABOVE the pectoral muscle but underneath the fascia ("subfascial") to minimize the risk of animation deformity (breast movement with muscle contraction), minimize post-operative pain, and mimic the natural anatomy of the breast which is all ABOVE the muscle. In a woman with very little breast tissue to camouflage the breast implant there may be no choice but to place the implant under the pectoral muscle.

Historically it was most common to place implants under the muscle, but this can lead longterm to what is termed a "waterfall deformity" in which the breast and nipple slide off the implant and the breast takes on an oval shape rather than a round shape. This is usually not apparent in clothing, bra or bathing suit, but is very evident in the nude.

Please consult with an experienced board certified plastic surgeon who can advise you on your options. Best of luck to you.

In my opinion they sure do. The muscle somehow kind of holds the implants in place. On Top they tend to end up as a "rock-in-a-sock" over time. Also, the upper pole is filled in Under and has a more natural look. Lastly, there is a much better (lower) rate of capsular contracture Under the muscle.

Good Luck!