Are implants under the muscle perkier if they are placed higher up?

Hello @Hepburnn thank you for your question. The implant tends to be placed high in the pectoralis when it is placed under the muscle. Nevertheless, we need to consider how much mammary gland is present in the area when placing a prosthesis under the muscle in order to obtain a harmonious result long-term. So, it is crucial to consult and formulate a surgical plan in advance with the patient. I link a video about prosthesis placement to shed more light. Best wishes! Alan Gonzalez MD, FACS

Hi, thank you for sharing your question. “Perkiness” or projection is based on the profile of the implant and does not have to do with the placement. Higher projection generally means that it will likely appear “perkier”.

Implants must be centred behind your nipples. If they’re placed higher than your nipples, this would create an abnormal appearance and result in something called “bottoming out”.

It doesn't appear that placement of implant, on top or underneath the muscle, will significantly affect projection and shape of the breast. In some cases, however, placement on top of the muscle, may create perkier looking breasts. Hope this helps.

If you have a totally submuscular implant then the muscle contracture will keep the implant up quite high and perkier. However, you will need a breast lift to center the nipple-areola complex higher to match it.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. I might disagree slightly with some others on here. And I am going to answer several of your questions together....

Shaped vs. round implant - this is up for debate, the honest answer is that either will work and some surgeons might have a preference for one or another. I actually prefer a shaped implant for these cases, especially if the patient has a severely deformed breast or very little glandular tissue. You want to make sure you choose a highly-cohesive gel implant, and now these come in both round and shaped, so there are options, but the highly-cohesive gel will help shape the breast over time, so whichever shape you choose, the shape of the final outcome will look more like the implant you choose (especially if you are small breasted to start out with). My preferred approach to a tuberous breast with enlargement of the nipple/areola is an incision around the nipple to place the implant (under the muscle usually, but this really depends on soft tissue/breast coverage thickness), scoring of the gland restriction in the lower pole, and then a periareolar mastopexy on the way out! But this same approach can be done with a shaped or round device.

Which implant type bounces/jiggles more softer? - my advice here is to choose a highly-cohesive gel implant, which is firmer but also ripples less and will do a better job at shaping the breast. If you choose a "softer" or less cohesive gel implant, the implant will be more likely to be shaped and formed by the breast than the other way around and this can be a problem when there is baseline shape deformity in the breast (tuberous breast).

Tubular breasts, saggy, tight, constricted. Over or under the muscle implant? - see above, in general the answer is under the muscle, but the implant can be placed over the muscle if you have enough natural soft tissue thickness and breast tissue to adequately cover the implant. If you do go in front of the muscle, I usually suggest using a textured implant (all shaped implants are textured) as the risk of capsular contracture is less with a textured implant than a smooth implant when placed in front of the muscle. This would need to be determined by an exam to find out what is best for you.

Hope this helps!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Dear Hepburnn,
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

After augmentation implants will settle along the breast fold, behind the nipple. A perkier look is more related to the size (volume) of the implant, shape, and profile (projection) of the implant. Your surgeon will work together with you to recommend the right style and size for the look you are hoping to achieve.

Implants behind the muscle do give better upper breast fullness and tend to avoid sagging because of the support. However, the implant is still placed behind the breast. If the implant is placed too high, it will look odd.

Implants must be centered under the nipple areoal otherwise the nipple will be either too low (if the implant is placed higher) or too high (if the implant is placed lower or bottoms out).
If you desire upper pole (top of the breast) roundness, then ask for a high profile, ultra high profile or high profile X implant (all Mentor breast implant products).
Dr. Taranow