Is It Better for an Implant to Go over or Under in a Tubular Breast?

During my consultation, my doctor suggested a lift on my larger side and two different size implants to deal with my severe asymmetry of 200cc. My smaller breast is also tubular. My doctor suggested that the implants go over the muscle. Is over or under better for tubular breasts?

My family also has a history of breast cancer. Both my aunt and grandmother had it. My mom was tested for it and she found out she was not a genetic carrier but that doesn't mean that she or I won't get it. What kind of difference will it make to have the implant go under the muscle vs. over?

Doctor Answers 14

Over or under for tubular breasts

I prefer in most cases to place implants under the muscle in a dual plane approach( the lower part really under the breast tissue).

New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Is It Better for an Implant to Go over or Under in a Tubular Breast? DO BOTH

Is It Better for an Implant to Go over or Under in a Tubular Breast? Generally, I prefer to the dual plane approach in which the gland is released above the muscle but the implant is placed below it.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 reviews

Implant placement in tubular breasts

As Dr. Baxter nicely said, I also like to place the implants under the muscle and since the result is very difficult to get perfect on the operating table with tubular breasts, I like to use the post-operatively adjustabe saline implants so we can modify the size and symmetry for several months after surgery until it gets as close as possible.

Augmentation in the tubular shaped breast

For individuals with a tubular breast on both sides, in general we would recommend a submuscular implant. The reason is that the breast is small by nature, and has a tightness below the nipple and smaller diameter. The submuscular implant gives better cover and keeps the implant hidden as the skin relaxes and thins over the implant. Often we use a round block suture around the nipple to reduce the forward prominence, also called a 'herniation' of the nipple.

I responded to your last question, and would like to continue with your asymmetry specifically. Other readers can move on. You noted a tubular breast on just one side, and considering the degree of asymmetry, it might be preferable to use a submuscular implant on the 'tubular' side, larger of course, and a smaller implant, subglandular on the 'normal' side. Here the reason is if the implant required is considerably smaller, say a 300cc on the tubular side, and a 150cc on the normal side, the subglandular implant may 'show' too much on the tubular side, and the submuscular 150cc implant on the normal side may to too small to blend in with the breast if behind the muscle; not a good marriage between the two. Therefore the best result may be submuscular on the small side, subglandular on the large side.

One other issue you raise concerning breast cancer screening, a good mammogram can be done with both submuscular and subglandular implants. You need not feel there is a trade-off to made one over the other.

Best of luck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 37 reviews

Correcting tubular breasts- over or under the muscle - not Breast Aug 101

Tubular breasts are a difficult problem. You can see by the varied recommendations of some of the finest surgeons below that there is no consensus on how to treat them.

In general , we have several theories about tubular breasts.

1. The lower pole of the breast is tight. We must respect that and not try for too large of an implant. Excessive scoring of the breast can kill the nipple or make it insensate. I have personally seen cases where this happened.

2. I prefer under the muscle augmentations with a conservative size, preferably in the dual plane technique.

3. Every effort should be made to correct the asymmetry as much as possible, usually with silicone implants to avoid the inherent differences between saline and natural breast tissue.

4. Lifts are almost always necessary to achieve relative nipple symmetry and reduce drooping.

5. Patients must be realistic. Their breasts will not be perfect with so many changes being made to the breast at once. Revisional surgeries are common once everything settles down, and an implanted breast ages differently than one with a smaller or no implant, so the breasts will become different over time.

These cases are the graduate course, not Breast Aug 101. You should have the distinct feeling that your prospective surgeon has a concrete plan, has considered all the elements, and is safe.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 119 reviews

Your doc is right, over the muscle and under the breast is best with tuberous breast

In my opinion it is best to reshape the breast through a peri areolar incision and place the a silicone gel implant implant under the breast and over the muscle. Often it is a good idea to do a nipple areolar reduction because they are often large with pseudo herniation of the breast tissue through the nipple areolar complex. 

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast implants need to go over the muscle to correct tubular breasts.


I think I answered another question of yours. When breast implants go under the muscle, they increase size but do not help with shape, which is the main problem in tubular breasts. Your doctor is right.

With an expert mammographer, you can get good examinations to detect an early breast cancer.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Implants for a patient with tubular breasts

Hi there-

Because the benefits of placing the implants under your muscle are so compelling, I would recommend this position for you, despite the tubular shape.

Given the tubular shape and your asymmetry, a dual plane technique would be best.

Prefer under in a tubular breast

Again without photos very hard to tell. But I always recommend 2 stages of surgery. I would prefer to go under the muscle.


Tubular breasts can be corrected with implants

Hello - Yes, tubular breasts can be corrected with implants over the muscle. However, if extensive work will be done around the areola you may want to get the implants under the muscle to prevent any blood flow problems to the nipple-areola area. As far as your risk for breast cancer, check with your family physician about getting tested for the gene. You may want to consider a mammogram before any breast surgery as a baseline to compare with future mammograms. Good luck!

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.