For saggy boobs, should I go for over or under the muscle implants?

Question

Have saggy boobs does placement of the implant matter which would be best for saggy boobs no lift over or under

Martin Jugenburg, MD · Answer

This is a common question. There a pros and cons with each. If you are trying to avoid have a lift and your natural breast tissue sits low than some  women consider placing the implants above the muscle. However keep in mind that with time the implants will drop. If you are getting larger implants they tend to be heavier and if you have only breast tissue supporting an implant vs the muscle supporting the implant, this tends to drop with time and gravity a lot faster. Other cons about going above the muscle is there is a higher chance of capsular contracture. Cons about below the muscle is animation deformity and you would need a breast lift so that the breast tissue can be at the level of the implants.

Gary M. Horndeski, MD · Answer

If your breasts are saggy then implants will solve your problem. You will need a lift. Many women do not like lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Irena Karanetz, MD · Answer

Hello and thank you for your question. 
It is difficult to answer the question without seeing photos, but sometimes, if the breasts are very droopy, a breast lift procedure may be needed in addition to placing the breast implants. 
A mastopexy (breast lift) will put your nipples into the correct position, decrease the size of nipple/areola and allow excess skin to be taken away, giving you a more youthful looking breast. Some people are a little apprehensive to the full breast lift due to the scars, but typically they do very well. 
Breast implants add the upper pole fullness and cleavage that many patients desire. 
I would recommend to obtain an in person consultation with a Board-Certified Plastic Surgeon to further discuss your options and expectations.
I hope this helps.
Best, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your question. Unfortunately without an in-person examination or full series of photographs it is difficult to offer advice. In most cases of breast sagging, the best treatment is to pursue a lift with an implant augmentation.

Daniel Barrett, MD · Answer

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

Connie Hiers, MD, FACS · Answer

If you are more deflated, then behind the muscle will give better upper breast fullness and coverage of the implants. If you need a lift, then behind the muscle helps support the weight of the implant.  Behind the muscle is a better choice for most women.

Bilgen Katipoglu Erenoglu, MD · Answer

I prefer to place the implants over the muscle for saggy breast, with or without breast lifting. Muscle is a firm and thick structure that prevents the lifting effect of the implant.
I can evaluate better if you send some photographs. Have an healthy day!

Camille Cash, MD · Answer

Most of the implants I place are beneath the muscle.  This provides a more natural look, lower capsular contracture rates, and the muscle "disguises" a portion of the implant.  Implant placement beneath nor above the muscle will take the place of a lift.  If a lift is needed it can often be performed along with the augmentation.

Gokhan Temiz, MD - Account Suspended · Answer

Hello and thanks for your question. Without pictures, It is impossible to see the sagging level you had on your breast but if there is a sagging skin, breast uplift operation usually have to be performed together with the breast implant. I prefer to use over the muscle placement in the breast uplift&implant procedures.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
Sagging (ptosis) of the breasts is due to overstretching of the skin (usually as the result of pregnancy or significant weight fluctuation) which permanently disrupts elastic fibers in the skin, causing the skin to lose its elasticity and stretch, resulting in breast sag.
If the sag is significant, a breast lift is required. If only minimal, however, retroglandular augmentation may be an alternative. However, if there is scant breast tissue, rippling  of the implant may be visible.
Visit a board certified plastic surgeon for evaluation and discussion.
Best wishes...

For saggy boobs, should I go for over or under the muscle implants?

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