Under or over the muscle? Does my skin look thick enough for over the muscle implant with a lift? (Photo)

Thank you for your inquiry! You decide how you want them and we can discuss options of making it work for you. We would love to meet with you to discuss your concerns. Schedule a consultation with a Board-Certified Plastic Surgeon!

Dear Gurlgirl131,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

There are many advantages to going under the muscle and these generally outweigh any potential benefits of going above the muscle. As a direct answer to your question, your photos show that you would likely have inadequate tissue coverage if the implants were placed above the muscle.

Under the muscle is the safer, more predictable procedure without a doubt. There are many reasons including a lower capsular contracture rate, less implant visibility/palpability, and longer more durable results.

Hi Gurlgirl,
Whether or not to put implants under or above the muscle is much more than just how they will look. In my opinion, the ONLY advantage, to putting implants in "over-the-muscle" is that the recovery can be easier. Otherwise, over-the-muscle implants: 1. can obscure mammograms because the implant interrupts breast tissue. 2. the implant support is solely on the skin, possibly causing earlier drooping. 3. your risk of capsular contracture is also higher with implants over the muscle. The advantages of under the muscle are 1. lower risk of Capsular contracture. 2. Nicer slope to the breast and some muscle support of the implant. 3. Implants are less likely to obscure the view in your mammograms.
I hope this gives you more insight into this decision. Keep in mind that every surgeon has their own opinion.
Best Wishes.

It is not a question of the skin thickness but how much breast tissue you have and since you are going to have a lift, that will change things. The technique I recommend is 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 or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Hello, in your case you have tuberous breasts, and you require lifting, the best is above the
muscle with lifting.

Under the muscle implants are always more safe and would give more advantages. Capsular contracture risks are much lower with under muscle implants, they give more natural result on the long term, implant rippling risks are lower too, that is why we prefer to use the implants under the muscle. The only disadvantage is the pain would be a little higher for the first 1-2 days after surgery, not severe pain, it would be manageable, but a little bit higher comparing with implants above the muscle.

You are an excellent candidate for a lift. It could be done above or under the muscle. I favor believe the muscle

Hello and thank you for posting. I will not go over all the pros and cons because you have obviously done your research on that. Yes you have enough enough skin and tissue for over the muscle implants if this is your preference. Both placements offer excellent results if done with silicone implants. When using saline implants, they should always be placed bellow the muscle because of the high chance of rippling.
Generally speaking, under the muscle implants stay in their place for longer. This means that it takes longer for them to settle and there is always a slight risk of them ridding too high in the chest. Sometimes needing extra help with massages and or pocket revision surgery.
Over the muscle implants tend to settle faster. And post-op is less painful but there is a slighter higher risks of implants dropping faster as well.
That said you should have great results with either. I feel this is not something you need to worry about. This decision should be done during consultation and the choice will mostly depend on what you and your surgeon are more comfortable with.

Best of luck,
Dr. Miguel Mota