Should my Implants Go over or Under the Muscle?

My consulting doctor recommended over the muscle. I am size 14 with a large C cup. I am also having a breast lift at the same time as the implants being put in, due to a supposid "shelf" that would be created once I got my lift. I want a very natural look, and the smallest implant possible put in, only used to fill up the space in the top of my breasts. I am happy with my size, just want them higher. Should I go with over or under the muscle with all of this in consideration?

Doctor Answers 10

Location of Breast Implants

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Thank you for the question. In my opinion,  there are numerous advantages of sub muscular (dual plane) breast augmentation. This  implant positioning will give you the best long-term aesthetic results and reduce the chances of complications such as significant rippling/comparability/ encapsulation and interference with mammography. Best wishes.

Warning! Combination Procedures

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Over the years I have seen too many bad results when doctors perform a lift in combination with implants. Some characteristics are; spreading of scars, widening of the areola, and implant malposition. I recommend my patients to have a lift first and allow proper healing to occur. Afterward a breast augmentation, especially if a doughnut or periareolar mastopexy or a crescent lift is performed.

Ivan Thomas, MD (retired)
Los Angeles Plastic Surgeon

Placing breast implants behind of in front of the muscle for a breast lift (mastopexy)

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There are many reasons to place the breast implants  behind the muscle and very few for them above the muscle - and that is just for a straight breast augmentation. Issues such as the ability to read/interpret mammograms better and a lower risk of capsular contracture are two of the most important reasons.

Having the need for a mastopexy means that your skin already is damaged - it has lost its elasticity. If you then place implants above the muscle, this same damaged skin will be the sole means of support of your breast implants. As a result, your skin will stretch at an accelerated pace due to the weight of the implants combined with the effects of gravity. Larger breast implants will accelerate this effect. You will end up with abnormal, droopy breasts with even thinner skin.

By placing them behind the muscle, there will be additional support for the implants and you will not get the same thinning of the tissues to the same degree. Your breasts will continue to droop though at a slower rate compared to if the implants were above the muscle.

Above the muscle has higher risk

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The concern with the combination of the lift and implant is the blood circulation to the nipple. The incision for the lift will compromise the blood flow to the nipple from the skin and implant pocket will compromise from the muscle. The other issue is the high risk of the complication with combined procedure .If you have enough tissue and do not want to go bigger,I would suggest to do the lift first and if you want more upper pole fullness latter on to get either implants or fat grafting.

The Submuscular Or Subglandular Position of Breast Implants Has Certain Advantages and Disadvantages

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While breast implants may be placed either above or below the muscle, there are several distinct advantages to going under the muscle and a few advantages to go on top. If a women has some significant breast sagging (nipple at level or slightly below level of lower breast crease), then the implant on top of the muscle may fill out the sagging tissue better and avoid a 'double bubble' or the breast tissue being pushed forward and down from being behind the muscle. Without any breast sag, however, placing the implant under the muscle is advantageous as there is another layer of well-vascularized tissue protection. If any form of a breast lift is being simultaneoulsy performed, the risks of wound healing and nipple survival problems is increased if the implant is placed above the muscle. All of these factors must be considered in determing which pocket level of a breast implant is best.

Breast implants over the muscle good option

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You seem to have enough tissue to cover the implant. So over the muscle is a good option for you. Naturally the breast tissue is located above the muscle. It could also be less painful over the muscle. Best of luck!

Implants Over Muscle Occasionally Good Idea

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Although I rarely recommend placing breast implants over the muscle, I think it would be okay in your situation.  The fact that you are already a full C cup and are requesting a very small implant would most likely lead to a good result in your case.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Implant and lift

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In general, I place the implants under the muscle as another layer of protection.  The size oif the implant will determine how "natural" they will look.

Breast Implants: Over or Under - The Debate Continues

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Any time I perform an augmentation and a lift, the implant is placed under the muscle.  There tends to be fewer issues with nipple viability (blood supply, which keeps the tissue alive), nipple sensitivity, implant edges visiblity and palpability (seeing and feeling the edges or ripples of the implant.  The breast tissue can also be lifted and shaped more significantly to get a better result.

Breast implants look more natural when placed under the muscle.

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I generally prefer smooth implants placed under the muscle using an incision around the areola or under the breast.  They look more natural and have less chance of sagging.

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.