Should I get my implants done over the muscle or under the muscle?

I had three consultations and two doctors said to go under the muscle and one said over the muscle. I am confused now and want to make the best decision and avoid rippling, etc. I really want to make the best most informed decision. Any thoughts? Thank you!

Doctor Answers 15

Over the Muscle or Under?

Most surgeons today will recommend placing the implant under the muscle also known as dual plane approach. There are a number of advantages including a lower risk capsular contracture, less risk of visible rippling particularly in the upper pole, and potentially a more natural looking result. There are some situations in which the on top of the muscle approach (sub glandular) might be indicated such as wanting to minimize any chance of animation change or a competitive athlete who wants to avoid any compromise of the pectoralis major muscle. Placement on top of the muscle is not a good choice for patients with thin tissues or larger implants which will thin tissues over time. This will put the patient at risk for an easily palpable or visible implant with rippling, higher risk of capsular contracture and a less natural looking result. 

Under or over the muscle

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Implant Placement

Hello,


There could be different reasons for advising one placement over another for each, individual patient. Sometimes submammary placement is recommended to address slight sagging which is not severe enough to warrant a  lift. In those cases your Surgeon must determine that there is enough breast tissue & fat to sufficiently cover the implant. 

I recommend that you ask for explanation and expected outcomes for the different placement options your Surgeons have recommended. As they have seen you and measured you, their advice will be based on the exams and discussion of your goals.


All the best 

Over the muscle or under the muscle?

In general, the benefits of submuscular breast implant placement are:

  1. Better superior (upper) coverage/hiding the implant in your cleavage where you will show them off the most

  2. Much lower rates of capsular contracture or scar tissue build up around the implant

  3. Most importantly, breast implants under the muscle do not interfere with your mammogram

I do not believe there to be any lasting benefit of subglandular (or sub fascial) placement. If your breasts are entirely below the muscle he will recommend a mastopexy (lift), not subglandular placement, to take advantage of the benefits mentioned above regarding submuscular implants.

A submuscular implant looks better, feels softer for longer and doesn’t interfere with mammograms, giving you the best chance at early breast cancer detection and highest cure rate should it develop. However, it’s not always that simple. Many times the bottom edge of the pectoralis major muscle ends higher than your natural breast crease. If the placement of breast implants lies completely under the muscle it “rides high” and delivers a less than ideal aesthetic result, with your natural breast “falling off” the front of the implant. Therefore, to prevent that, I frequently utilizes a dual plane implant placement. This means as much of the upper portion of the submuscular implant is under the muscle, for all the reasons listed above, but a small portion of the implant “peeks” out from under the muscle so the implant is nearly centered under the nipple. There are different degrees of dual plane release (I, II, III) but I will do as little a release as possible to achieve an optimal aesthetic result, thereby leaving maximum muscle coverage. During your breast augmentation consultation I discuss breast implant placement options, and during the exam I will determine where your pectoralis major muscle ends compared to your breast fold to estimate the level of dual plane release required to optimize your breast appearance.

 Hope this helps.

Under or over

If you are slim then under the muscle will help lessen rippling in the upper half to two thirds of your breasts but the implant is not covered below that. to have more chance of avoiding ripples a form stable smooth implant would offer more security

Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  

Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon


Over vs. Under the Muscle Augmentation

Some basic summary of breast implant placement:

Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle.  The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.

Over the Muscle (sub-glandular) –  Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.

Dual-Plane - This placement method is a more current technique most often used when there is mild breast sag and the patient does not want a breast lift. The breast tissue and muscle are partially separated to allow the breast tissue to sit in a better position. Dual-plane can be discussed further during the consultation should breast sag be of concern.

For women with moderate to severe breast sag, a breast lift (mastopexy) may be recommended to ensure the best result and longest lasting result. Failing to have a breast lift when necessary will only lead to a less than ideal result leaving the patient unhappy and needing a revision surgery. A larger breast implant can help lift the breast, but the low hanging breast tissue will still be present causing a disconnect between the implant and breast tissue located at the bottom of the breast.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Under the muscle

There are several advantages of placing your implants under the muscle instead of over the muscle.  I almost always suggest placing the implants this way.  In addition to having less of a chance of rippling, there is less chance of having capsular contracture in the future.  Also, the results often look more natural this way.  Best of luck!

Jonathan Heistein, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 22 reviews

Should I get my implants done over the muscle or under the muscle?

The most common placement of breast implants is under the muscle.  There are several advantages to under the muscle placement including better coverage of the implant for a more natural upper pole transition, less risk of developing capsular contracture, and better imaging of your breasts in the future with mammograms.  Speak with the surgeon that recommended above the muscle placement and ask him/her why that option would be chosen.

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 62 reviews

Implants and where to put them

99.9% of my breast augmentation surgeries are UNDER the muscle. They look better, they offer higher quality mammograms and they are susceptible to a lower rate of capsule contracture. Any questions?

Talmage Raine MD FACS

drraine.com

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon
4.5 out of 5 stars 8 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.