Why Would my Doctor Recommend Above the Muscle Breast Implant?

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.

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

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

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.

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.

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.

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!

Most breast implants are indeed placed under the muscle, though not all, and this will depend on available tissue coverage, the implant size, lifestyle, and the available skin envelope. With good cover and a small implant, perhaps just for upper fill, the subglandular approach might be just right for you.

The most likely reason is what you have stated in your question...slight drooping of the breasts. It is not rare for plastic surgeons to consider placing the implant above the muscle in an effort to provide more of a breast lifting effect. There are advantages and disadvantages to subglandular breast imlpant placement and these need to be compared and contrasted to submuscular placement so you can make an informed decision. 

Without proper consultation and examination, it is difficult to recommend the proper placement. Position of the implant above the pectoralis muscle is known as subglandular placement and offers some advantages. This operation involves less discomfort and faster recovery because the pectoralis muscle itself is not disturbed. Your breasts will immediately appear attractive because swelling is minimal. In athletic muscular women it causes less movement (distortion) of the breast when flexing the pectoralis muscle. Women with ample breast tissue might be more likely to select subglandular placement than women with very modest breasts as larger breasts offer more of a cushion between the implant and the skin, thereby not needing the additional padding conferred by the muscle. You should follow up with your surgeon as to his/her thinking as it will be a factor in providing informed consent.