Can I go over the muscle with a small implant? (Photo)

I'm 19 and my breasts are very saggy. I'm getting a lift but I'm not sure if I want to get implants. I've read about animation def. And even without implants I can move my breasts with muscle contraction so I'm really worried about that. I thought I could get them over the muscle(because I have a fair amount of tissue)but everyone here says that's the worst thing one can do. But what about small implants? Maybe 200cc's texturized low profile. Would that really cause a lot of problems?

Doctor Answers 8

Can I go over the muscle with a small implant?

Thank you for your question.  You do have nipple ptosis and will need a breast lift in addition to implants placed under the muscle.  Subglandular implants would risk the "ball in a sock" appearance and could result in the snoopy deformity.

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

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



Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 91 reviews

Can I go over the muscle with a small implant?

What are the options for breast implant placement?

There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:

Subglandular implant benefits:

·         A shorter recovery time.

·         Less discomfort initially.

·         No distortion of the breast when the pectoralis muscle flexes.

·         Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.

·         Easier surgical procedure.

·         Larger implants can be placed.

 Subglandular implant disadvantages:

·         The implant may be more visible.

·         More visible rippling, especially in patients with a small amount of natural breast tissue.

·         Generally, saline implants do not produce a good result in front of the muscle.

·         Higher incidence of capsular contraction.

·         “Bottoming out” in some patients.

·         Some radiologists have more problems reading a mammogram with an implant in front of the muscle.

 Submuscular implant benefits:

·         Usually results in a better appearance for naturally small breasted women

·         Less tendency for seeing ripples of the implant.

·         A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.

·         Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.

·         Lower rate of capsular contraction.

·         Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.

Submuscular implant disadvantages:

·         Recovery usually takes a little longer and is more uncomfortable initially.

·         There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.

·         It is harder to achieve cleavage in women who have widely spaced breasts.

·         The implants often ride higher on the chest.

Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.

The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach and desired outcome..

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.  

Robert Singer, MD  FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Implant over the muscle vs. under the muscle

Your question is a common one. You will definitely benefit from a breast lift, and most patients would also opt to have implants (otherwise you will end up with smaller breasts). In my practice it is most common for patients to have implants placed under the muscle. This results in a more natural look and avoids the "double bubble" look that can happen over time. Make sure that you consult with a board-certified plastic surgeon about the type of implant that best fits your frame since you have a bit of space between your breasts. 200cc sized implants are quite small and will initially look even smaller when placed under the muscle. Over time, the implants will settle into the pocket and result in a very natural look. 

Mark E. Mason, MD
Dallas Plastic Surgeon
4.3 out of 5 stars 26 reviews

Can I go over the muscle with a small implant?

Thank you for your question. Based on the picture lift with implant give optimal results. Placement of implant under muscle is definitely advantageous than over in your case. Please discuss this with your PS

Ven Erella, MD
Austin Plastic Surgeon
4.9 out of 5 stars 31 reviews

Breast lift with implant

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  With that being said, based on your photographs, the best shape and contour could be achieved with an implant and a wise pattern breast lift. Your nipple sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A wise pattern lift with an implant can result in a very nice shape if good technique is used.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Can I go over the muscle with a small implant?

The advantage of placing the implant behind the muscle includes more natural looking cleavage - you won't see the edge of the implant, a better mammogram in the future and a decreased risk of forming a capsule. Most think that these benefits are worth the small risk of an animation deformity. Good luck!

Keith Hodge, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 27 reviews

Lift with implants

I really depends if you want to have larger breasts.  If you are happy with your size, but just want them higher up, then go with the lift alone.  If you want more volume, then you will need implants as well.  Most implants these days are placed at least partially under the muscle for a variety of reasons.  There will always be some degree of animation deformity when placed under the muscle, but this is acceptable to most women.  The other option is to just have a lift first and see how you like it.  You can always go back later and have an augmentation.  Best of luck!

Josh Waltzman, MD, MBA
Long Beach Plastic Surgeon
5.0 out of 5 stars 15 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.