Under the muscle or over? (photos)

Question

I had my consultation for my breast implant surgery and the surgeon said if my main concern is upper pole fullness then my best bet is to go with silicone over the muscle because if i go under..the muscle pushing on the implant can cause it to lose some of the upper area fullness. Is this true?

Steven Goldman, MD · Answer

It can be confusing and frustrating for patients when doctors have different opinions about matters like when to place breast implants over versus under the muscle. The advantages of over the muscle implants are as follows:       --more upper pole fullness (not less) and more medial fullness (cleavage);       --a higher, perkier result;       (I disagree with your physician's statement that over the muscle implants have more upper pole fullness; I think most plastic surgeons feel the opposite is true).        --probably lower capsular contracture rate;       --better soft tissue support (less droop) over time;       --less rippling.Over the muscle implants will have a lower position which some doctors do consider more natural, but the implants, in my opinion, look lower, heavier (more droopy), and may have more rippling. Some physicians will place implants over the muscle in weight lifters or body builders because under the muscle implants can move up with strong pectoralis muscle flexion. But body builders are more prone to rippling as they loose body fat, so under the muscle will usually look more natural. I have several patients who have won competitions with under the muscle implants.Some physicians will place implants over the muscle when patients have mild droop. My observation is that the droop generally worsens due to the poorly supported weight of the implants when placed on top of the muscle. To reiterate, it can be frustrating to get different opinions from different doctors, but I think the advantages of the subpectoral plane strongly favor it versus the subglandular plane. Thanks for your questions. Good luck.

Rodger Shortt, FRCSC · Answer

The pocket placement, the choice of implant style, implant size, breast volume, muscle thickness all play a factor in creating the perfect shaped breast to match your individual goals.  Some surgeons consider all those factors, some just pop them in and you get what you get.  Generally speaking though the muscle coverage will diminish the full round upper pole appearance somewhat.Dr Rodger ShorttOakville Plastic SurgeonDirector of Cosmetic Surgery Training Program &Assistant Clinical Professor,McMaster University

William Townley, MD, FRCS(Plast) · Answer

Hi Michelle. It is true that implants placed on top of the muscle are more likely to deliver a round and full upper pole. However, implant placement is not the only key factor. Selecting an implant with a high profile (the amount it projects form the chest wall) will also produce upper pole fullness even when placed under the muscle. There are other considerations when choosing pocket placement and only a full discussion during the consultation will guide you in the right direction. Good luck!

Keith Hodge, MD · Answer

I think you can still achieve upper breast fullness with high profile implants under the muscle. You would also have the advantage of more natural looking cleavage, better future mammograms and a decreased risk of developing a capsular contracture. Good luck!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate
your question.

The best way
to determine implant size is based on chest wall measurements that fit your
body.  Once we determine that we can choose the profile based on what you
want or need to achieve.

Implants
under the muscle, there is less risk of capsular contracture.  Anatomic
implants tend to give a more natural shape with more nipple projection.

The best way
to assess and give true advice would be an in-person exam.  Please see a
board-certified plastic surgeon that specializes in aesthetic and restorative
breast surgery.

Best of luck!

Dr. Schwartz

Under the muscle or over? (photos)

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Under the muscle or over? (photos)

Answers (10)

Answer: Under the muscle or over? (photos)

Answer: Under the muscle or over? (photos)

Answer: Under the muscle or over?

Answer: Under the muscle or over?

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.