If I Am Getting a Lift and Natrelle Implant Can I Go Under or over the Muscle? (photo)

I want to go under the muscle but the Dr said it probably wont be. I am also getting a large tummy tuck

Doctor Answers 9

If I Am Getting a Lift and Natrelle Implant Can I Go Under or over the Muscle?

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Thanks for posting the photo. I would approach you in a staged operation. Stage 1 Full lift, Full TT with lipo. Stage 2 Breast implants. This isa my opinion based upon the info and photo. 

Should the implant go under a muscle when getting a lift?

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You can have the breast implant placed either above or below the muscle.  If the implant is placed under the muscle, it will likely sit higher up and thus you will require a bigger lift.  Placing the implant over the muscle won't require as much lifting and will leave you with an implant that sits a little lower.  Which look is better?  That depends on your perspective.  Under the muscle will give you 'perkier' look, while over the muscle will give you what I would call as a more 'natural' look.

As the the benefits of over vs under the muscle, going under has a lower risk of capsular contracture, going over less painful and has a quicker recovery, and the implants do not move with muscle contraction.


Martin Jugenburg, MD, FRCSC

Implant pocket

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I prefer in most patients to place implants below the muscle because it can camouflage the upper pole better, especially in very thin patients.

Breast lift and implants at same time

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Based on your photo, I personally would place the implants under the muscle, and do a lift at the same time. While each plastic surgeon has his or her own preferred techniques, I do not see a good reason to place them above the muscle. Placing implants under the muscle reduces the risk of capsular contracture. Also, the lift will involve manipulating the breast gland, and by placing the implants under the muscle you avoid further manipulation of the blood flow to the gland and nipple areola complex. For the lift, I prefer a superomedial pedicle to help maintain more fullness in the cleavage and less “bottoming out” or drooping over time. Some surgeons advocate doing a lift and augmentation in two separate procedures. With careful planning and technique the two can be combined in one surgery. It may be that your surgeon was trying to communicate that even when the implant is placed under the muscle, the lower part of it is technically under the gland because the muscle only extends down so far.


You do not need implants

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You have fair amount of breast tissue and implants will make your breast too big and sag too early. Implant are for patients with small breast tissue . I would recommend lift only if you are happy with your breast size when wearing bra.

Breast Implant Placement

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Most doctor's opinions lean toward submuscular placement of implants, and for good reason.  Looking at data available, there is a clear association between subglandular placement of implants (overs) and a higher risk of complications like rippling in the upper portion of the breast, capsular contracture, and unpredictable tissue stretch, especially with larger, high profile implants.

Your doctor's decision not to honor your wishes makes me concerned, and also makes me wonder what kind of breast lift he was planning; you are not a candidate for a limited incision breast lift, and would not be served well by one.

I recommend you place your plans on hold with this doctor, and have another consultation with a breast surgery specialist, one with a great reputation for breast lifts, reductions, and revisions.  This doctor would be certified by the American Board of Plastic Surgery, and also be a member of the American Society for Aesthetic Plastic Surgery.

Best of luck!

Breast implant pocket location

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I know you will get  different opinions on this from plastic surgeons so I will make it clear that this is my opinion.  I strongly prefer to use an under muscle pocket for long term stability.  I have seen too many patients seeking revision because of pocket thinning and implant visibility in the above muscle position.  The above muscle pocket works great in the short term but after several years the tissue thins and the implant becomes too visible and palpable.  The under muscle pocket has more pain in the early time period but the long term benefits are worth it.

Best Wishes

Dr. Peterson

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Breasts Implant Positioning (Sub Muscular or Sub Glandular)?

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Thank you for the question and picture.

In my opinion, 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.

Under or over the muscle?

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Based on your photo I think you could go either way. It also depends on the size of the implant. The larger the implant the more I would recommend under the muscle in order to avoid too much visibility of the implant. I think that there is slightly less long term capsule contracture when the implant is beneath the muscle as well. 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.