Why Would my Doctor Recommend Above the Muscle Breast Implant?

5'2 140lbs B cup - plenty of natural breast tissue slight drooping wanting to have fullness at top of breast

Doctor Answers 13

Implants above the muscle

It is difficult to say why your doctor is recommending implants above the muscle, without pictures and/or physical examination. in some cases of sagging putting the implants under the muscle would require some kind of a lift vs putting the implants over the muscle without a lift. please follow the advise of a board certified plastic surgeon and discuss your options with him/her.

San Diego Plastic Surgeon
5.0 out of 5 stars 5 reviews

Above the muscle for breast implants

With the patient who is very heavy set with a lot of fatty tissue in the breast with ptosis or sagging of the breasts it is best to put it on top of the muscle and in particular tuberous breasts, which are a breast abnormality.

John S. Poser, MD
Gainesville Plastic Surgeon
3.8 out of 5 stars 11 reviews

Putting implants above the muscle

It is not simple to say why your doctor would recommend to place the implants above the muscle.  Many times when it is done, it is for shaping reasons- for example if you have tubular shaped breasts.  I would recommend asking your surgeon for more specific information to help you make a more informed decision.

Mennen T. Gallas, MD
Katy Plastic Surgeon
5.0 out of 5 stars 19 reviews

Implants above the muscle-only a temporary fix

Hi Joy,

I NEVER place implants above the muscle because I know what the outcome will be in a couple of years - low/saggy 'rock in a sock' look. It's not pretty. Placement of implants above the muscle have only the skin for support. Every woman knows skin is simply not enough to hold anything up. Yes, breasts look great the first couple of years, but quickly stretch the skin and tissues to create a problem that is very difficult to correct. Submuscular placement at least provides somewhat of a shelf for the implant to rest upon. FYI, the larger the implant, the more likely this shelf is to fail. That being said, there is a new technique called the Mini Ultimate Breast Lift that lifts and drapes your existing breast tissue directly over a small submuscular implant to create a perky, round, and natural appearance. Internal straps are created to maximize the lift and secure it for longevity.

I hope this helps,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

Above the Muscle Breast Implants

There are many reasons for placing breast implants above the muscle. I prefer that placement in anyone with droop, as it allows me to better raise the breast tissue, not just push an implant high. It is the preferred placement for anyone who is athletic or uses the arms significantly. There is also evidence that it reduces the implant rupture rate. From your description, you have adequate tissue superiorly to cove the implant. Therefore, you should have no problem with implant palpability. The present implants and insertion techniques have a reduced risk of capsular contraction. If that worries you, the textured implants reduce the risk even further for a prepectoral breast implant.


Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast Implants above the muscle (sub-glandular)

When I have a patient with moderate breast volume and some droop (ptosis), I do offer them silicone sub-glandular implants. This enables me to fill in the superior pole of the breast as well as expand the breast envelope in a way that is not possible with sub-muscular placement. The alternative is a breast lift of varying degrees with sub-muscular placement. The sub-glandular approach enables me to give a good result to a patient who might otherwise be better off with a lift as well as implants. It tends to have less pain and a quicker recovery as well. Finally there is less implant displacement with contraction of the pectoralis muscle when it is placed above the muscle. The alternative argument is that the bigger they are, the harder they fall-because the muscle is not supporting the implant as much, they are more responsive to long term gravity effects. There is no absolutely right answer. Make sure that your surgeon is board certified and experienced in breast augmentation and get a second opinion if you still have questions.


All my best,

Daniel A. Medalie, MD

Daniel A. Medalie, MD
Beachwood Plastic Surgeon
4.9 out of 5 stars 35 reviews

Implants above the muscle

Sometimes implants are placed above the muscle in patients that have ample breast tissue. I usually place them below for added soft tissue coverage in the superior pole.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast implants above or below the muscle?

If you have already have some "slight drooping" your doctor is probably trying to avoid the scars related to a mastopexy, aka, breast lift. If you are a bodybuilder, it would be appropriate to go over the muscle, also known as subglandular.  Those would be the 2 main reasons for placing the implants subglandular, as opposed to under the muscle, also known as subpectoral.  It would be best to have an examination by a board certified plastic surgeon if the initial surgeon cannot explain their recommendation.  Best of luck to you.

James E. Chappell, MD
Annapolis Plastic Surgeon
5.0 out of 5 stars 18 reviews

Why Would my Doctor Recommend Above the Muscle Breast Implant?

It is hard to say why a surgeon makes a certain recommendation without examining you. I do most implants under the muscle because we get a more natural look in the upper breast where the muscle hides the implant edge. But I use a dual plane technique so the muscle actually pushes the implant into the lower breast in someone with a little droop. This gives the most natural look of all. If your surgeon is not using the dual plane technique you may want to get some more opinions before making a decisiion.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Why would implants be placed above the muscle?

Difficult to answer without an exam and pictures. Would tell you that placement above the muscle does have some immediate advantages but also has some long term disadvantages. If you are not happy with the recommendations I would recommend another consultation with a  BC Plastic Surgeon,important for you to feel comfortable with his/her recommendations. Good Luck!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 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.