Is it Better to Place the Implant Under the Muscle or Under the Mammary Gland?

Hello, I want to enlarge my breasts but I don`t know where it is better to be the implants, under the muscle or under the mammary gland, and why? Please, please help me. Thanks,

Doctor Answers 25

Above or below the pectoralis muscle

It is not possible to be certain from the photo but the first issue is whether a lift (mastopexy) is required before an implant can be considered. If the nipple is more than two centimeters below the level of the inframammary crease behind it then a proper mastopexy (actually moving the gland with it's nipple-areola attached up on the chest wall) is required before an implant can be properly positioned. 

The overwhelming consensus and experience is that breast implants need to be below the pectoralis muscle in the upper pole (above the nipple) to pad, protect, and blend in the implant as well as separate the implant from the breast tissue for at least half of it. Those who feel otherwise, in my opinion, don't seem to be able to properly size and position an implant below the pectoralis muscle and adjust the free lateral border of the muscle to accomodate the implant. 

A breast implant is just pillow volume and will not lift the breast. Properly done, there is a lift "effect" but no actual lift. It must also be properly sized and positioned in the lower half of the breast to look natural. You have some degree of asymmetry (right breast higher than the left) that would not be corrected by an implant alone. If an implant is placed above the pectoralis muscle in your situation, it will be very noticeable and unnatural looking even if it's not saline-filled. 


Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

IMHO, It is ALWAYS in your best interests to place implants behind the chest muscle

Hi there-

The only advantages (to the patient) to placing implants over the chest muscle are: it is a bit less painful, and (according to some) it is better for correcting mild drooping of the breasts.... there are advantages to the surgeon (shorter operation, more operations per given time, more $$)...

First of all, please know that when performed by an experienced surgeon, sub-pectoral (under the muscle) breast augmentation causes only mild pain that lasts for a few days.

With regard to correction of drooping: while it may be true that in the immediate postoperative period breasts that were a little droopy look less droopy when implants have been placed over the muscle, this is a VERY short lived improvement, as the implant and gravity take their effects on the (already loose and stretched) breast tissue and skin. After a short time, they will look like you are carrying bowling balls inside pillow cases...

There are so many advantages to you of placing them under the pectoralis muscle- it is the only way I would allow a loved one to do it.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Under the muscle

Implant placement under the muscle carries several advantages, it reduces the risk of rippling, reduce the risk of capsular contrature and mammogram is easier to  interprit when the implants are under the muscle. For that, i agree with most of the comments made her. The issue of whether you need a lfit of not has to be addressed with your plastic surgeon. The physical examination and seeing before and after photos of patient wih similar situation is advisable. It is also advisable to show your plastic surgeon photos of what you think is good results for you. This will help you and your surgeon in arriving at the right procedure for you. Good luck

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Mastopexy and augmentation

I think you will benifit a lot from breat lift( mastpexy) with/out augmentaion. You have a good volume from your breast tissue when its lifted up can give a very nice shaped breast, with skin resectin only and reshaping your breast. Still you have the option of augmentation if you wish for more volume after the lift. on that case both options for the pocket (submuscular/ subglandular) will give good results. You need to discuss all the pros and cons of both your surgeon, good luck.

Fatema S. Alsubhi, MD
UAE Plastic Surgeon
5.0 out of 5 stars 3 reviews

Better to Place the Implant Under the Muscle or Under the Mammary Gland?

Respectfully, your breasts lost some of their volume and have sagged. A breast augmentation will add volume but will not raise the breasts significantly. To do so would require a breast lift , Mastopexy.

Since there is NO perfect breast implant and all of them will have a variable degree of rippling when stood on edge (in the natural breast on the chest position), we want to cover the breast implants with as much of your tissue as possible. this hides the rippling and is best dome when the implants are placed under both the pectoralis major muscle and the overlying breast tissue.

Trouble often starts when surgeons try to use a hammer as a screw driver and attempt lifting the breast with a very large breast implant placed over the muscle. While this will cause some elevation of the breast, the lift will be very short lived and be associated with both loss of the overlying breast tissue and rapid re-sagging of the breasts. This in turn would require a breast lift - the operation these women tried to avoid in the first place, often with "down sizing" to smaller implants.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Breast implants above vs. below the muscle

Because implants do not blend in well with surrounding tissues at their edges the usual recommendation is to place the implants under the muscle for those who have very little body fat or breast tissue to start with. The goal is to maximize the amount of tissue between the edge of the implant & the outside world/eye. The muscle we refer to is the pectoralis major whose lower border only reaches to the nipple or above the nipple in women. Thus only somewhere between 30 & 60% of the implant ends up being covered by muscle. Implants placed under the muscle tend to stay in a higher position on the chest wall as they are held there by the muscle. This can be problematic if the lower muscle fibers are not disrupted or the patient is past their 20s-30s and the breasts droop to some degree. In such cases if you then just put the implant behind the muscle it separates from the native breast tissue that continues to drift downward with aging and the drooping that comes with aging.

Your photo shows breast drooping more so on the left than the right with little breast tissue in the upper half of the breasts. I assume you want the surgery at least partially in order to fill in the upper halves of the breasts. That will not happen if you leave the breasts as they are and just put the implants in above the muscle. In that case the implants will just move to the bottom of the breasts and accentuate the drooping. You will need a breast lift (the specifics of which cannot be known without a face to face examination). The implants could then be placed under or over the muscle but each approach would have its own pros and cons. A lift with an implant above the muscle has a significant risk of stretching out again and needing another lift sooner rather than later. There are other pros and cons but this is not the appropriate forum to go over all of them. That is best done by your surgeon as part of the informed consent process.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast Implants Under the Muscle vs. Under the Breast Gland

There are many advatages to placing breast implants under the muslce.  First of all, the implants appear more natural as the muscle provides for a natural slope at the upper pole.  Also, there is a smaller chance of seeing the implant rippling when they are placed under the muscle.  Lastly, there is a significantly decreased risk of a capsular contracture - which is when the implant capsule, which is normally soft and not apparent, becomes thick, contracted, and often painful - when placing the implants under the muscle.  

The one benefit of placing the implants under the breast tissue and over the muscle is that the implants can provide a lift for someone whose breasts have a sag to them as they can be placed directly under the sagging breast tissue to lift them up.  Placing implants under the muscle for women who have sagging had always risked the dreaded "double bubble deformity" where you could see the outline of the implant with the breast tissue falling off of it.  For those women, a breast lift was recommended.  However, a "dual plane" augmentation can now be done which retains the benefits of being submuscular while giving the lift effect of being subglandular.  

It is important to discuss the many options available, and 3D imaging can give someone an idea as to what the breasts would like like after surgery, both with a lift and without one. 

Gary D. Breslow, MD, FACS
Paramus Plastic Surgeon
5.0 out of 5 stars 44 reviews

Considering all of the facts, under the muscle is better.

The more surgeons that answer your question, the more opinions you will get and,  unfortunately, the more confused you may be. My opinion is that breast implants are best under the muscle and in you need a lift, get a lift.

Implants on top of the muscle are easier to see and feel, have a higher risk of capsular contracture and rippling, they tend to sag more over time, they get in the way more when getting a mammogram and they make it harder to get a lift in the future if that becomes necessary.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Over or under?

Innyour photo, your breasts look ptotic. Sometimes putting implants under the breast will give you enough of a lift, or you might need a mastopexy with implants. I believe that implants should go in the same plane as your breasts, that is over the muscle. Especially when you are ptotic, under the muscle is the wrong place to go.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Breast implant above or below the muscle

In looking at your photos it appears that your own breast tissue is lower than the edge of the muscle, and ideally the implant is placed with the nipple as its bulls-eye. Taking that into consideration, you would need to have it placed above the muscle, unless you had a breast lift performed at the same time as the breast augmentation.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 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.