Implants without lift? Would over or under muscle implants work better? (Photo)

I hate how tiny my breasts are. My BMI is 23, I'm a healthy non-smoker, but I want to avoid a lift because of the scaring and just incase in the future I ever have another baby, I want to minimize the risk of breastfeeding difficulties. Would over or under the muscle implants work better? I want large breasts if I can and ideally I would like to avoid a lift. Is this possible? (I don't know why my photos uploaded upside down by the way... I'll try to fix that on my PC)

Doctor Answers 12

Breast Implants

Hi Mommy, Please put an index card in your breast fold. If your nipple is at the edge of the card or below, then you would be a candidate for a lift, either a vertical or anchor or areolar incision. If your nipple is above the edge, you could be a candidate for an internal lift called the dual plane. The dual plane is PARTIALLY under the muscle. The video below explains the dual plane internal lift.  I also attached an article from a peer-reviewed journal to give you an even better idea.  I believe the dual plane and implants alone will do it for you, and that you will not need a lift. Be sure to seek a consultation with a BC PS to be sure. All the best, “Dr. Joe”



Minneapolis Plastic Surgeon
5.0 out of 5 stars 278 reviews

Implants without lift? Would over or under muscle implants work better?

Thank you for the question and pictures. Based on your photographs, I think that you will be best off undergoing breast augmentation/lifting surgery. Again, based on your photographs, I doubt that you'll be pleased with the outcome of breast augmentation surgery alone.


I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 


On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  that can be seen with breast implants placed in these sub muscular position.    


Best wishes your decision-making and for an outcome that you will be pleased with. 


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Breast lift

I prefer in the  majority of cases to place the  implants under the muscle for more soft tissue coverage. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Implants without lift? Would over or under muscle implants work better?

If you are not ready to have a lift, I would recommend that you have the augmentation as a first stage procedure, then allow them to settle before deciding on any type of lift. Thin women with very little breast tissue usually have fewer issues with palpability and capsular contracture with dual plane or subpectoral implants. If you choose this approach, your nipples will sit low on your breast mound without a lift. I would also recommend that you avoid the temptation to use a large implant in hopes of filling out more of the skin. This often results in breasts that are too large for your frame and that sag more over time.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 73 reviews

Over or under the muscle Implants. Lift or not?

Hello and thank you for your question.

I would place your implants under the muscle. You have very little tissue in the upper portion of your breasts, so  placing the implants under the muscle will help hide them better. There is also less risk for capsular contracture if the implants are under the muscle. As for the lift, I think you could get away with just  a periareolar lift or "donut" lift. This is where the scar is only around the areola. There is no other scar on the breast skin. Neither of these procedures should prohibit you from breast feeding in the future. Hope this helps!

David L. Cangello, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 15 reviews

To lift or no to lift

I can understand your hesitancy in not wanting to undergo the scarring associated with a breast lift.  If you are OK with where your breast footprint lies on your torso, and are willing to receive a large implant, then you MAY find the result you wish. 

I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery.

Best wishes!

Dr. Desai

Urmen Desai, MD, MPH, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 233 reviews

Implants with or without a lift

Many woman find themselves in the predicament of whether or not to have a lift with implants.  Ultimately, you may have to weigh whether a better size and shape aesthetic is worth the scar.  It's a decision you should discuss with your plastic surgeon to learn all the risks and benefits of either choice.

In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always have an in-person consultation with a plastic surgeon certified by the American Board of Plastic Surgery.

Best of luck,
Keith M. Blechman, MD
New York, NY

Keith M. Blechman, MD
New York Plastic Surgeon
5.0 out of 5 stars 19 reviews

Trying to avoid a lift

In my experience implants over the muscles tend to lift up the nipples better than implants under the muscles. Also the larger the implants the more they will fill out the emptying of your breasts. However, if you are not wanting to go too big, another option is to try anatomical shaped implants which add more projection to the lower pole of the breasts, and so help lift up the nipples. 

Anthony Barabas, MBBS
Cambridge Plastic Surgeon
5.0 out of 5 stars 19 reviews

Implants without lift?

It is imposible to accurately answer you question without actually examining you but I think it may be possible to place implants in the "dual plane" both on top of the muscle below the nipple and on top of the muscle above the nipple. This allows the lower pole to stretch and the move the center of the implant lower to where your low nipple is. A shaped cohesive gel implant like the Allergan 410 would be best. You may want to have a periareolar lift that only leaves a incision above the nipple in the junction of the nipple and breast skin to help move the nipple up. This heals great and is a good compramise. Good luck.

Robert Graper, MD
Charlotte Plastic Surgeon
4.4 out of 5 stars 27 reviews

Implants without lift

I think that is a good option as you may have more children. Implants over the muscle usually gives more of a lift effect. Higher filled Sientra gels or Natrelle Inspira implants would work nicely.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Harry T. Haramis, MD, FACS
Montclair Plastic Surgeon
3.7 out of 5 stars 19 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.