Under the muscle or over? (photos)

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.    

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

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!