Implant over or Under the Muscle for Me?

I'm 5 foot 2 between 103-110 lbs (gym go-er) I've wanted implants for years but am terrified of the recovery for under the muscle surgery, would over the muscle work for me? Im aware of the less natural look with over the muscle but I tend to prefer the "fake" look, I do not want large implant so picked out 270cc's but my PS thinks I should go with 325. I haven't set a date or anything yet. I took boards on mammography and know that radiologists prefer them under the muscle for mammo views?

Doctor Answers 15

Implants above or below muscle

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If you are going with saline implants, I would definitely recommend going under the muscle, otherwise, you will likely notice rippling in the upper portion of the implant, especially since you are quite thin.  The pain of going under the muscle seems to correlate with the size of the implant.  the larger the implant, the more it stretches the muscle and the more it will hurt after surgery. the size range of 275 to 325 is reasonable. The difference would probably equate to a small C versus a mid or full C, and that is a decision only you can make. The pain from the surgery I'll  bet will be a lot less severe than you fear.

San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Implants above or below the pectoralis muscle

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The reason to place a breast implant (partially) under the pectoralis muscle is because many years of experience have shown that that is the best way to do the procedure for both short term and long term results. The muscle pads, protects, and blends in the implant and has a number of real or potential advantages over implants above the pectoralis muscle. The one trade-off of increased animation on pec flexing is minimized by the dual-plane technique and is quite acceptable to most women. I see so much variation in postoperative pain complaints that I'm not convinced there is any real or significant increase in postoperative pain with sub-pectoralis positioning but if there is it's just in the first week and that isn't a good reason to compromise the long term result and advantages. You might get away with a sub-mammary (above the muscle) silicone gel implant now but you will likely eventually regret that choice. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Choosing to go above or below the muscle with breast implants

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I would recommend a submuscular implant for most patients, except those that are extreme body builders who pose in certain positions with their arms up and their pecs flexed.  

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

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Breast Implants Under or Over the Pectoralis Muscle?

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Thank you for the question.

Although patients who have breast implants placed in the sub muscular ( or dual plane)  position may experience more discomfort during recovery, I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” 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 in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

Above or below muscle for breast Implant placement

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Dear Meghan, This is a common question. There is no quick and easy answer, it depends on your body if you have enough tissue to cover the implant. I personally prefer the above muscle approach for the following reasons: the breast is naturally above the muscle, there is less animation ( movement of the implant ) with contraction of the muscle. There is also less pain during recovery. Radiologists are trained to perform techniques to see breast tissue such as the Eklund technique. In short it depends on how much breast tissue you have, the kind of implant and your personal goals. Best of luck!

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

There is a lot to consider...

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There is a lot to consider when deciding if the implant should go over or under the pectoralis major muscle.  It sounds like you are thin and muscular with a small chest and little subcutaneous cover.  The muscle can hide ripples and lend a more "natural" look.  I have spoken to mammogram technicians who prefer implants under the muscle.  The under muscle placement may result in a lower rate of capsular contracture, also.  You will have some jumping or flattening of the implants when you activate the muscle if it is under.  Most of my patients are asking for sub muscular placement.  As far as size, look at your breast diameter and compare to the implant diameter so it fits your body.  You can do the "Rice Test" to check what size you like.

D`Arcy Honeycutt, MD
Bismarck Plastic Surgeon
4.7 out of 5 stars 24 reviews

Implant pocket location

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In the majority of patients that I treat, they are often very thin and under the muscle adds another layer of soft tissue coverage.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast implants under or over the muscle?

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I put the majority of implants in UNDER the muscle as they: look more natural, feel more natural, may (?) interfere less with mammography and may result in less capsular contracture (hardening of the normal scar tissue that normally forms around implants. As for size, would have to examine you to give you my opinion. 

Implant over or Under the Muscle for Me?

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In general implants look better across their top if the edge of the implant is covered with enough soft tissue so it doesn't look too artificial. Also, if the patient is very thin like you, there may be some visible rippling in the upper breast, even with silicone. Most of my patients are done under the muscle with a dual plane technique and we use pain pumps so the pain is well controlled and they require very litle in the way of medication otherwise. As to size, the 275 can look very nice on a tiny frame like yours, probably in the full B to small C range. That depends on how much breast tissue you start with.

One disadvantage to the under the muscle placement it sometimes a litle movement of the implants when flexing the muscles at the gym. You have to balance this drawback to the better look and decide for yourself which is the most important quality for you.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Implant location

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If you choose to place the implants above the muscle, I would only use gel filled implants.  Without seeing pictures or examining you, I can only guess that the size implant chosen by you is preferable.

Michael Leff, MD (retired)
Bellevue Plastic Surgeon

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.