I'm having a difficult time deciding behind or above the muscle? (Photo)

I've had a consultation with a few plastic surgeons and one of them told me to get a more natural look i should go above the muscle due to how "prominate" my chest cavity is and the slope of my breast ...(to avoid bulging) but my thing is...will this pull my boobs down and cause them to sag? and will this effect the lifespan of the implants? the first picture is me....the rest are wish pics. I'm debating on 350 cc - 390 cc I'm 5'4 107 pounds 32 b/c bust

Doctor Answers 15

Dual plane breast augmentation is a submuscular implant position

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The data demonstrates that the risk of capsular contracture and other implant related complications is lower when implants are placed in the submuscular position. Most surgeons trained in the modern era employ a 'dual plane' technique in which the majority of the implant, with the exception of the lower implant pole, is covered by the pectoralis muscle.

Where to put a breast implant on top or below the muscle?

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Dear Ms. Beautyxkills,

Thank you for your story, questions and photos.

I would suggest you visit some reputable board certified plastic surgeons to have complete assessment and review of all your options.
Usually sub muscular augmentation in dual plane is the best option. 
If you put a very large implant on top of the muscle it can cause sagging in long term.

Dr Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Implants and the muscle

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I prefer placing the implant under the muscle.  I think the look is better and the risk of capsular contracture is lower.  Every surgeon has their own preferences and you need to decide what makes the most sense for you.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

Breast Augmentation: Information

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Dear Ms. Beautyxkills,

Thank you for your story, questions and photos. Unfortunately with out a exam of your tissues I can can only comment based your photos.
In my practice I personally almost always place implants under the muscle (dual plant) unless the patient is a professional weight lifter (animation issues).

Placement of Breast Implants
1) sub pectoral, dual plane
+ less chance for internal scarring (capsular contracture)
+ padding from the muscle therefore less chance of implant palpability
- varying degree of animation upon pectorals major contraction ( breasts moving)
- longer immediate recovery
2) supra pectoral
+ in borderline ptosis (breast sag) can provide alternative to a mastopexy
+ faster immediate recovery
- increase chance of internal scarring (capsular contracture
- increase potential for breast implant palpability.

I trust that you have chosen a Plastic Surgeons who is experienced and Certified by the American Board of Plastic Surgery. In addition ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

I wish you my best and success,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Above or under the muscles

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Given the current data, implants below the muscle have less capsule contraction and slightly lower infection rates. Implants in this plane also tend to have better longevity as the muscle
provides internal support. Use of an anatomic implant will create a natural appearance if that is the goal. 

Arko Demianczuk, MD
Vancouver Plastic Surgeon

Natural look

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Breast augmentation is all about a healthy conversation between patients and their surgeons. I would recommend finding a plastic surgeon that really listens and tries to understand what your goals are for a natural look especially based on your individual anatomy and chest. A board certified plastic surgeon's office can have sample implants to help you visualize what the implants look like (anatomic, round) and how they feel (textured, smooth, saline versus silicone). Best of luck! MMT

Above or below the muscle

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By your height and weight, I assume your very thin.  If your breasts are sagging, then I would suggest submuscular to give you an additional layer to hide the implant.

Christopher Costanzo, MD
Thousand Oaks Plastic Surgeon
5.0 out of 5 stars 40 reviews

Breast Implants / Breast Augmentation/ Cohesive Gel Implants / Silicone Implants / Revision Breast Surgery

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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
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute

Implant Position

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Prominent surgeons from around the world can debate the merits of below versus above the muscle placement, but one thing is for certain that we'd all agree upon is that a large implant like the one you are contemplating will have a prominent upper pole fullness that will not blend with the rest of the chest, creating the 'fake' look.

As for the other issues I stand on the side of the majority of my American colleagues, and feel that dual plane, sub-pectoral placement of an appropriately sized implant, placed correctly will lead to decreased risk of capsular contracture and rippling, with little risk of animation deformity.  Above muscle placement will hasten a dropped out look because of release of all the breast/skin attachments to the underlying muscle.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

I'm having a difficult time deciding behind or above the muscle

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In looking at your pictures, your natural breast tissue is lower on your rib cage. The amount of implant that will remain under the muscle in your case would be very small to nothing if the implant is centered behind your nipple, which is the desired location. Implants above the muscle do have a higher chance of capsular contracture though. I think that placing an implant in the dual plan location and really keeping it there would require you to have a breast lift and reposition your own breast tissue higher to where the dual plane implant would reside

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

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.