I do not want a lift - can I go over the muscle with saline or silicone implant?

It’s difficult to give you an opinion without photos. However, since you’ve stated that your breasts are saggy, then a lift may be recommended. The implants need to be centred behind the nipples, so if your nipples are located lower down on your chest, that’s where the implants will be as well.This could give you a “rocks in socks” result that may be unsatisfactory. During the lift, the constricted tissue can also be released to make your breasts less tuberous in shape.

Most sagging breasts are not tuberous, but many tuberous breasts sag. If you do not want a lift, the implants can be placed just behind the breasts. However, you will have larger and still sagging breasts.

The disadvantage of placing an implant over the muscle is 1. the skin envelope is the only thing holding the implant up and 2. the major sensory nerves are cut to the nipple-areola complex. This is often done for tubular breasts. A better alternative is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.