Is over or Under the Muscle a Better Choice for a 475-500cc Implant?

Doctor says that unless I'm a AA cup he will not do under the muscle and no matter where I read I get different information. Help me, so confused!!!!! So what would be better for a 475-500cc high profile silicon implant ( from a A-B cup depending on bras to start with) over or under the muscle?

Doctor Answers 9

Is over or Under the Muscle a Better Choice for a 475-500cc Implant?

I will toss in my thoughts here that agree with the others' comments. Those are large implants for a thin AA cup individual and place you at high risk of problems. I prefer under the muscle for several reasons outlined by the others.

Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

I almost always place Breast Implants under the muscle

There is less chance for capsular contracture if implants are under the muscle, as well as more tissue between the implant and the breast tissue for looking for breast cancer.  I dont worry about my patients breast feeding if the implant is under the muscle as much either, because of the tissue blockage between the implant and the breast tissue because of the muscle if they were to get a mastitus.  There is less chance of rippeling if under the muscle as there is more tissue above the implant and the muscle flattens out the implant.  For all of these reasons, I think it is safer for my patients generally to have their implants placed under the muscle.

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 33 reviews

Pocket placement for implants

First, those are big implants for someone who is an AA. Second I prefer under the msucel expecially in patients with not alot of tissue because it miimizes rippling.

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

Subglandular(over), subpectoral (under), dual plane (combination of over and under muscle)

You are not the only one to be confused by the options for breast implant placement.  Historically, when implants were first introduced in the late 1960s, they were mostly silicone gel and all placed over the muscle in the subglandular plane. 

In my residency training, 1993-96, this was what we learned, however I eventually abandoned this technique, with the exception of certain cases: a) women who already had ample breast tissue and refused subpectoral placement and b) women who have constricted and/or tubular breasts but refused skin modification.  It's accurate to understand that there is more initial discomfort, however the long term benefits certainly offset it. 

Most of the other consultants agree that the subpectoral (under muscle) plane is associated with lesser capsular contracture, better appearance of the upper pole, provides some protection against mastitis associated with lactation, should offset gravity, (assuming the implant isn't excessively heavy/large) and most importantly is preferred by radiologists who interpret screening mammogram.  The so-called "dual plane" is a variant of "under" the muscle and reflects some modification of the pectoral muscle's attachment to the breast bone.  Hope this helps.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Over or Under?

Based on your description of your current cup size the short answer would be to place your implants under the muscle.  The reason being  is that the tissue over the muscle is relatively thin and would readily show the outline of the implant.  This would cosmetically displeasing.  

REMEMBER IT IS THE ANATOMY NOT THE IMPLANT SIZE that determines whether to place the implant above or under the muscle.

Dr. ES

Large Breast Implants and Muscle Position

Almost any woman who has smaller breasts (A-B cup) would benefit from placement of the implant beneath the muscle. This is true even if the implant is of a smaller volume - and yours is on the larger size 475-500 cc. The muscle is used to help camouflage the implant, provide a more natural upper breast, reduce the incidence of capsular contracture and can help with mammography down the road.  An above the muscle placement does allow for a slightly quicker recovery, but not much more.  Thus, I'd seriously consider revisiting the issue or going for a second consult.

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Breast implants under the muscle offers many advantages

Breast implants placed under the muscle generally look more natural than implants placed over the muscle, especially if you are thin and using high profile implants.  Medically, this position offers better protection against capsular contracture and make mammography easier to perform once the implants are in place. 

It is true that placement under the muscle is more painful than placement over the muscle, but the long-term benefits of sub-pectoral placement and the availability of pain medicine makes that irrelevant. You should discuss this with your surgeon and perhaps find a new one if he or she is unwilling to reach some sort of compromise with you.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 16 reviews

Over or under the muscle a better choice for a 475-500cc implant

Placement of the implant is NOT based upon size of the implant! You need additional in person evaluations to fully understand. Also ask about expander implant or adjustable post surgery implant.

From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Over or under the muscle in a smaller breasted woman

The goal of going under the muscle is to provide better coverage of the upper and inner implant edges. It only makes sense then that a woman with smaller breasts would benefit from this procedure. Note though that the larger the implant you chose, if your breast tissue can accomadate it, will overpower your natural shape and lend a less natural look.

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 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.