Above or Below the Muscle for Saline Implants? Differences?

I'm 5'-6", 116 lbs and I want to know what is better, above or below the muscle for saline implants?...and would like to know what the differences are, if any?

Doctor Answers 9

Saline implants below the muscle

There are some basic differences between placing breast implants above or below the muscle. I prefer to place implants below the muscle to achieve a more natural appearance. Saline implants are more likely to ripple and placing the implants under the muscle provides an added layer of camouflage.

For low body weight, place saline implants UNDER the muscle

SEE VIDEO BELOW FOR OVERVIEW>>>>There are numerous previous responses which have answered this qeustion. However, the brief answer to your question, in my opinion, is a strong recommendation for under the muscle due to your being typically under weight for your height.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 reviews

Salines should always be below the muscle

Because of increased wrinkles and ripples with saline above the muscle, they should ALWAYS be below the muscle in my opinion.

Saline above or below for implants

Most of the patients I see are pretty thin.  Usually I place them under the muscle to offer more soft tissue coverage in the superior pole.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Saline implants above or below the muscle?

I prefer implants above the muscle if you have enough tissue in the superior chest. My reasoning is that they are less likely to leak, do not move with arm movement and are less likely to displace late. A major reason for submuscular implants is that they stay softer than subglandular implants, unless you use a textured implant. A textured implant has the same incidence of feeling firm whether above or below the muscle. The reason most surgeons use below the muscle implants is that it is an easier procedure than using a textured implant. If you have thin tissues, then I use a silicone implant above the muscle. With saline, I have the option now of using a shaped implant that can give very natural results. With really thin tissues you should have a submuscular implant for the most natural result.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Saline implants should usually be under muscle

Saline implants should almost always be placed under the muscle in order to provide better coverage for the implant and a more natural look.  Saline implants above the muscle will usually have a lot of rippling, especially in someone your size.  Even with a implant below the muscle, you should really understand the pro's and con's of saline vs. silicone.  Good luck!

Dean Fardo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Go under the muscle with saline implants in a thin patient

One of the more important reasons to put implants under the muscle is for coverage. With ample breasts and thicker body fat layer, it doesn't make much of a difference but it does not sound like you are in that category. Even with going under the muscle though, saline implants will not feel as natural as silicone gel implants, and keep in mind that the muscle does not cover the lateral sides or the bottom.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 38 reviews

Placement of Saline Implants

I think saline implants should almost always be placed under the muscle.  They ae more likely than silicone implants to develop wrinkling.  By placing them under the muscle the rippling can be somewhat hidden.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews


Very few women who require implants look attractive with over the muscle saline breast implants. The reason? ALL breast implants, but especially salt water (saline) implants ripple and pleat. To prevent these ripples from being seen and felt Plasticsurgeon want to put as much soft tissue cover on the implants as possible. If the woman does not have a lot of breast tissue to cover the implant, the underlying pectorals major muscle needs to be used to provide cover as well. In addition to less rippling and pleating of the implants, submuscular implant placement is associated with a lower risk of scarring around the implants (less capsular contracture) and easier mammography diagnosis of breast masses. In a thin woman the vast majority of Plastic surgeons would advise a submuscular breast implant placement. Hope this helps. Dr. Peter A. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 85 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.