Any Difference Between Having Implants Under the Muscle and Having Over Muscle?

i am 5.4 and 117 lb, i ware a 34 A and i am looking for a gel 325 cc. i am nervous about all i don`t know and i want to look like a natural breasts and not like i got some lollypops. Thank you. Also any difference between textured and plain.

Doctor Answers 21

Saline implants better under the muscle--Gel implants no difference above or below.

Placement of the implant above or below the pectoralis muscle has no effect on capsular contracture.  Saline implants are more liable to have visible contour irregularities if placed above the muscle.  Silicone gel implants have no aesthetic difference above or below the muscle.

Atlanta Plastic Surgeon
5.0 out of 5 stars 25 reviews

Implants above or below the muscle

I am a firm believer in placing implants partially under the muscle for better coverage and I think a decreased chance of capsular contracture. This will provide a more natural appearance for the average patient but this depends on your starting breast volume and the size implant you chose. There is no one size fits all approach so the best thing to do is to have a consultation or two with board-certified plastic surgeons to see what your most appropriate options are.

I hope this helps.

Dr. Edwards

Implant placement choices

I prefer smooth implants, under the muscle.  This generates in my opinion a more natural look, less capsular contractures, better mammograms, and less implant palpability.

Any Difference Between Having Implants Under the Muscle and Having Over Muscle?

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement.

Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.

Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.

Hope that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 17 reviews

Under the Muscle vs.Over Muscle

For thin women, there is a greater risk of rippling which can be reduced if you have submuscular placement. While there has been some studies that have indicated lower probability of capsular contracture with textured implants, smooth implants is generally my preference. Consult with 3 - 4 experienced and expert board certified plastic surgeons to review your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 32 reviews

Over vs. Under muscle

Having the implants placed under the pectoral muscle may help you achieve the natural look you desire.  The muscle helps to camoflauge some of the nuances of the implants.  The lower outer portions of the implant are not usually covered by the muscle, but the upper portion is, which is the part more visible when wearing a bathing suit or certain style tops and dresses.

Mennen T. Gallas, MD
Katy Plastic Surgeon
5.0 out of 5 stars 17 reviews

Under the muscle implants are best

Since you are thin and size 34 A, you have small breast volume.  I would definitely recommend silicone gel implants.  They are less likely to ripple, feel more natural and the implants should be placed behind the muscle to provide additional padding and long term support.  Implants can be placed through an incision around the nipple or inframammary to hide the incision in the shaodw of the breast.  In your case, I do not recommend implants in front of the muscle.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.5 out of 5 stars 193 reviews

Implant positioning and texturing of implants.

The choice of implant placement - under or over the muscle - depends mostly on the ability to camouflage the implants. For women with minimal breast tissue (as is likely with a 34A cup), the usual recommendation is for placement under the muscle. This avoids the visibility of the implant in the upper portions of the breasts and provides a smooth transition from the upper chest to the breast. The choice of texturing vs. smooth implants depends on two factors:

1. Capsular contracture concerns - some studies show a slightly decreased risk of contracture with textured implants

2. Shaped vs. round implants - all shaped implants are textured to provide some adhesion between the implant and the capsule to minimize rotation of the device. Round implants may be either smooth or textured.


Hope this helps!

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 15 reviews

Under the Muscle

Most women will benefit from placement of the implant under the muscle.  To be accurate, only part of the implant is placed under the muscle.  The lower portion of the implant is usually not covered by muscle so you can get more expansion of the lower breast but this also allows the lower implant to be felt more easily.  Placement under the muscle should also help with mammograms and reduce the risk of capsular contracture.  On the other hand, the recovery following submuscular placement is somewhat more uncomfortable and you will have more movement of your implants when you contract the muscle.  I have stopped using textured implants as the evidence that they reduce capsular contractures is debatable and they can result in more rippling and a less moveable, less natural feeling breast.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 65 reviews

Above or Below The Muscle ?

Thank you for your question.

Based on the information you provided it would appear that you are slim and would have thin tissue above an implant.  This would make the implant more visible and susceptible to rippling if placed on top of the muscle. 

Here are some of  the benefits of under the muscle, the difference between saline vs silicone, and textured vs smooth implants. 

Less visibility of the implant and rippling under the muscle.  Silicone will be less visible (more natural looking) more natural feeling and less rippling vs a saline implant.

Lower capsular contraction rate under  the muscle.  This is well documented in the literature.

Better visualization of breast tissue on mammograms when placed under the muscle.

Textured implants tend to adhere to the surrounding tissue when placed on top of the muscle and cause more rippling.  Using textured implants under the muscle in primary breast augmentation is used less commonly than smooth implants.  However, in secondary revisions sometimes a textured implant may be more beneficial. 

This is just a summary.  Please consult with an experienced board certified plastic surgeon for a more in depth discussion of breast augmentation.

Best Wishes,

Dr. Brian Joseph


Brian Joseph, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 48 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.