Under the muscle or on top? (Photo)

The surgeon I have seen has said that I should have the new implants on top of the muscle to fill the empty skin and avoid the sag again. Only problem with that is rippling? If I go for a lift and new implants plus removing the capsule should the implant go under of on top of the muscle???

Doctor Answers 8

Under or Over the Muscle During Breast Lift

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Over the muscle placement of the implants has the advantage of a more natural result because both the breast implant and your own tissue are on the same hight. On the other hand, when implants are placed under the muscle, they are kept high by the pectoral muscle and your own tissue tends to sag over them with time, requiring revisions. In summary, Over the muscle placement is best, even though you have a higher risk of rippling. 

Mexico Plastic Surgeon
4.5 out of 5 stars 10 reviews


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Hello dear, thanks for the question and provided pictures, I recommend you to have soft cohesive silicone implants under the muscle

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 441 reviews

Depends on your surgeon

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Similar to what is mentioned below.  In my hands I would perform a remove and replace with silicone breast implant and place them in a neo-subpectoral pocket and perform a breast lift.  This will provide better medial cleavage, lateral control and upper pole fullness.  Wrinkling will be less as well.
You certainly will get similar results using other techniques.
Best Wishes,
Nana Mizuguchi

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 55 reviews

Should the implant go under of on top of the muscle?

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My advise to you is to keep the implant in the same pocket as before and do a lift. This way you will avoid the ripling and at the same time you will have a well lifted full breast.


Shady Hayek, M.D. 
Plastic and Reconstructive Surgery 
Beirut, Lebanon 

Breast Lift

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You could have a breast lift without implant replacement.  The only reason to change implants is to change size, you have a capsule, or you are changing type of implant.  If you have salines, you may want to go with the new cohesive gel.  The look and feel is natural.  Discuss your concerns with your surgeon.  If he is experienced and board certified, he will know exactly what to do.  

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Under the muscle or on top?

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With newer gel implants being back on the market in the US and more highly cohesive (thicker gel) silicone, which has been available for years outside the US, it is becoming increasingly popular to place the implants over the muscle as the problems with rippling are less.  However, in someone who is having problems with droopiness and needs a lift, I would recommend leaving the implant under the muscle to help support the weight of the implant and avoid further droopiness or worsening droopiness down the road.  Best of luck!

Jeffrey A. Sweat, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 51 reviews

Breast Lift

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My suggestion would be to leave the implants under the muscle and do a formal breast lift.  Simply transitioning to a subglandular pocket will not sufficiently address the problem and perhaps lead to worse ptosis after several months.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 56 reviews

Under the muscle or on top?

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Thank you for your question and photos.
There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular).
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 the sub muscular position.
I suggest visiting with well experienced, board certified plastic surgeons who can demonstrate significant experience helping patients with this type of revisionary breast surgery
I hope this, and the attached link, helps. Best wishes.

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.