Which would you recommend; over or under muscle. What is a more natural look? (photos)

I'm confused with both! Have read that over is more natural and under! What do you think? Why do they do both? I'm a a small b. Bf fir a total of 5 Years so I do have some room to stretch and fill! I'm thinking of a 500 cc silicone Tear drops.

Doctor Answers 12

Under or over the muscle breast augmentation

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Under the muscle with definitely give you a more natural look. The muscle covers the top portion of the implant and thus hides the line created by that part of the implant since you are a small B cup. It also will hide any potential rippling that could occur in that area. Most real plastic surgeons go under the muscle. Also tear drop implants do give a more natural appearance but it not like you can't get a natural look with round implants. 

Beverly Hills Plastic Surgeon
4.6 out of 5 stars 106 reviews

Under or over the muscle breast augmentation

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Dear Rach,
  Thanks for submitting your picture, though, bra less front and side view pictures would have been very helpful. I have been in plastic surgery practice for 28 years and performed breasts augmentation on thousands patients. My exclusive technique is placing the implants under the muscle for the following reasons: 1. Less nipple sensation loss, since the nerves cross on top of the muscle. 2. Statistically, less capsule contracture. 3. Better coverage of the implants , resulting in less palpable implants and less ripples, especially in a thin person like you. As far as size selection, you did not provide your chest circumference measurement ,which is critical for the correct size selection. Let's assume that your are 34 small B , 500 cc implants will bring you to 34 small DD. Is that what you had in mind ? In my opinion, it is excessively big. 34 full C or small D cup would be a better choice and the implant size for that would be, roughly, 350 cc. In regard to implant type, I use almost exclusively , smooth, round, moderate profile saline implants for the following reasons : 1. Cost  $1000 less . 2. Allow for small incision under the areola , which is scar friendly as oppose to silicone implants that require most of the time long incision in the IMF (infra mammary fold ) which is scar unfriendly. 3. The incision under the areola allows for the creation of nicer cleavage and fold, due to ability to do that under direct vision and precise digital dissection. The sub mammary incision is too far for that. 4. When the implants leak or rapture, the saline implants replacement is very simple ( can be done under local anesthesia ) , where as the silicone implants replacement is complex. 5. Capsule contracture is more prevalent with silicone implants than saline implants. Finally, it is wiser to choose the surgeon rather than the tool or type of implants. Always, select  experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive. Pay special attention to the cleavage area, the perkiness, the symmetry and the natural look.
                Best of luck,
                                    Dr Widder

Implant position

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I prefer to place them under the muscle in most instances.  The muscle adds another layer of soft tissue coverage in the upper pole.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Which would you recommend; over or under muscle. What is a more natural look

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Hi... thank you for the question... in my practice, i have had these type of cases, the under muscle technique is usually the choice to protect the implant in very small breast tissue, usually in these cases to get c cup 350-400cc is the choice.

Luis A. Mejia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 83 reviews

Implant position

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Implants placed beneath the muscle have several advantages. Making  a more natural transition from chest wall to breast mound is one of them. The tone of the muscle prevents a visible edge that can sometimes be seen. Implants placed above the muscle avoid the distortion of the implant that comes with muscle activity. As you can see,It is best to discuss this with your surgeon to fine the best option for you.

John S. Alspaugh, MD, FACS
Virginia Beach Plastic Surgeon

Natural look

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There are pros and cons to each placement, and therefor, one location is not "better" than the other. If someone wants the most natural appearance they can get, silicone Implants on top of the muscle is the most natural. when you put implants under the muscle, then you can get distortion of the breast shape when you contract the pectorals muscle. Minimal in most people, but significant in others. This is a decision you need to discuss with your surgeon.
Good luck,

Greg Sexton, M.D.
Columbia, S.C.

Which is more natural-looking?

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Thanks for your question. It is difficult to assess which is best for you, but generally the submuscular implants give a more natural look. An in-person examination with a Board Certified Plastic Surgeon will help you assess which is best considering your specific body goals.  

All the best,


Look is not predictable!

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The final look is not predictable.  Tear drop implants can end up looking liking half grapefruits and round implants can end up looking tear drop.  There are many factors that determine the final outcome.  The tear drop shaped implants do tip the scale towards a more natural look, but are not a guarantee of a natural look having placed a number of shaped implants.  There are a number of advantaged to place the implants sub muscularly.  You should consult with an American Board of Plastic Surgery certified plastic surgeon to help determine what would be the best size for you, based on your chest and breast dimensions, skin and breast tissue and style and size of implant.

Todd C. Case, MD
Tucson Plastic Surgeon

I prefer submuscular (dual plane)...

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Thank you for the question.
There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position. I hope this, and the attached link, helps.
Best wishes.

Which would you recommend; over or under muscle. What is a more natural look?

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Generally speaking for a thin person like you placing the breast implant underneath the muscle will provide more coverage of the implant and has many other advantages especially in thin small breasted women.

500 cc breast implants are huge and in my opinion will look unnatural on a patient of your build and size.  Please see a board certified plastic surgeon who offers breast implant sizing using specially shaped implant sizers in a non-padded bra.  For more information choosing breast implant size please read the following length:

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.