Does putting an implant under the muscle make it look smaller?

Hello, this is Dr. Woo Jung Kim from WOOA Plastic Surgery Korea.
Submuscular placement can create the appearance of a smaller size compared to the same implant placed over the muscle. This occurs because visual effects of submuscular placement:
- Muscle compression reduces projection- Broader, more gradual slope creates less dramatic appearance- Additional tissue coverage distributes volume differently- More natural contour may appear less "full"
As 55cc difference is small and with submuscular placement, the change is even subtler. High-profile implants add projection that can offset muscle compression. The anatomy and chest dimensions ultimately determine the final look and would suggest to consult with your surgeon.

The short answer is: Yes, submuscular (under the muscle) placement can make implants appear slightly smaller–especially in the upper pole–compared to over the muscle placement. This is because the pectoralis muscle provides an additional layer of coverage, particularly in the upper chest which can subtly dampen the projection of the implant and make the transition look more gradual. For women with a smaller frame or limited natural breast tissue, under-the-muscle placement offers a more natural contour and helps to reduce the risk of visible rippling. However, the final look also depends on multiple other factors–implant profile, chest with, tissue characteristics, and surgical technique.
Dr. Brandon LambirisBoard-Certified Plastic Surgeon–Sarasota, FL

Your implant will probably have a softer margins and this may make it generally looks smaller. Because of this, patients may want to opt for a little bit more volume. The volume difference between the implants you mention is about the same volume of 4 tablespoons of fluid. Many people would not consider this much of a difference.

Dear RSMember12714,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Since the implants are positioned partially beneath the muscle, the surrounding tissue may initially compress that area. As you heal and the tissue gradually expands, the implants should experience less compression, allowing for a more natural feel and appearance.

A difference of 55cc is small and is mildly visible. It would be a good idea to try on both sizes at your doctor’s office to see which you prefer.

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

• Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster
when compared to subpectoral augmentation.

• Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

• Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

• Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

• Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pectoralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

• Subpectoral implants have a lower rate of capsular contracture.


• Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

• The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

With regards to your specific question, I would not struggle over small volume variations. 55 cc is only slightly more than a shot glass (44 cc) and is unlikely to be a "make or break" decision.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other. As always, your board certified plastic surgeon can help guide you in your decision making process.

Whether the implant goes above or below the muscle does not matter with regard to the implant volume. The advantage of under the muscle is less demarcation of the implant border and a more natural appearance, although if you have quite a bit of breast tissue or fatty tissue already this is not an issue. High profile implants are commonly used to reduced "side boob." A 55 cc difference is not much. If you want large, go with the larger volume.

Putting an implant underneath the muscle does not make it appear smaller, but it does supply camouflage to the edges of the implant. The best way to determine the proper implant sizing for you is to have your plastic surgeon perform dimensional measurements of your breast to determine what the natural boundaries of your breast are and to choose an implant based upon these measurements. This allows the natural boundaries of your breast, which are responsible for holding your implant in place, to remain intact. Different implant profiles: moderate profile, moderate profile, plus or high profile, give different shapes to the breast because the implant shape is slightly different. The choice of which profile to choose is dependent upon the patient’s wishes. As the difference between one implant size up to the next implant size is very minor, in order to truly affect a change. you usually need to go up at least two or more likely three sizes before you would see a difference. Best wishes.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Yes, implants placed under the muscle can appear slightly smaller due to added tissue coverage, especially in the upper pole. The difference between 430cc and 485cc is about 1.8 tablespoons—noticeable to some, but not dramatic. If you're between sizes, most surgeons recommend going slightly larger to avoid regrets.