I Am 28 5'8 165lbs 36A Wanting Saline Implants Uncertain Over/under Muscle?

Doctor Answers 30

Implant Selection Process

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It is always better to place the implants under the muscle if all possible.  It decreases the risk of implant related complications and offers less implant visibility.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Usually, Saline Implants Are Placed Under Muscle

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First, consider what your body type is and how much of your natural breast tissue you have. If you are thin and have little of your own natural breast tissue, then chances are sub muscular placement is better. This is because the implants (regardless of whether they're saline or silicone) won't be as palpable. Their outline won't be as visible, as well, giving you a more natural result in both feel and look.


Saline implants tend to create more visible rippling than silicone. As a result, it is more common for saline implants to be placed under the muscle. The muscle fibres cover the implant, hiding rippling better. This is a generality, though, and it really depends on how much natural breast tissue you have. If you have more, then this may not be a concern.

Having said all of this, however, it really depends on the expertise of your surgeon.  Speak to an experienced and reputable surgeon for their opinion following a physical assessment. Rely on them to make the decision, and I'm sure they'd be able to achieve a beautiful result.

Under the muscle is BEST

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At size 36 A each 200 cc of implant will correspond to 1 cup size change.  Once you know you desired size then you can calculate the size implants you will need.  Since you are very small (size A), implants will be palpable through your skin.  I would recommend underneath the muscle for this reason.  Also, silicone gel implants feel and look more natural than saline and will not ripple as frequently as saline implants.  I suggest you consider silicone gel implants placed retro-pectoral.  Also, the smaller the implant the less complications you will have long term and less revisions.  You have not described whether your breasts are drooping or not.  However, if you do have a problem with hanging breasts you may need a simultaneous lift.  There is a new technique called Breast Augmentation with Mini Ultimate Breast Lift, which lifts at the time of implant placement but avoids the ugly vertical scars of the lollipop or boat anchor shaped incisions.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Implant Under or Over Muscle?

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Whether using silicone or saline implants, most women choose going under the muscle because it gives you a more natural look.  It also makes reading your mammograms easier, so that alone is a great benefit.  With saline implants, going under the muscle may be better choice because the muscle and breast tissue will help to camouflage the implant better and help give you a softer more natural look.  There is a good chance you may feel the implant more and possibly see and feel rippling around the sides and the bottom of your breasts if you don't have enough of your own breast tissue.  Make sure to talk to your surgeon about which he/she recommends for you at your physical exam and touch and feel the implants as well.  Best of luck!

Andrew Smith, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 24 reviews

Saline implants over or under the muscle

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With saline implants I always go under the muscle.  I like to have as much coverage as possible so that it looks as natural as possible with the least possibility of rippling.

Kenneth L. Stein, MD
Chicago Plastic Surgeon

Implants above or below the muscle

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Thank you for your question.  This is a very common question that many women have.  As with so many things in life, there are trade off's with placing an implant in both positions.  



In order to safely place an implant above the muscle, there must be adequate breast tissue to help cover the implant.  If not, a person will be able to see the implant easier, they will be able to feel the implant easier and as you get older and need mammograms, the radiologist may have more trouble seeing the breast tissue around the implant.  


Placing an implant under the muscle allows for more tissue to cover the implant which gives it a more natural feel and look, it will have a lower incidence of scar tissue getting firm around the implant and will make it slightly easier for radiologists to evaluate mammograms.  The muscle can shift the implant slightly if the pectoralis muscle is used, causing an "animation deformity".  


Most plastic surgeons probably prefer to place implants under the muscle for the above reasons, although if you have adequate tissue coverage near the top of your breast, you could be a candidate for either.  A consultation with your plastic surgeon can help determine which is best for you.


Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

Saline Implants

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Whether you are a candidate for a saline implant should be determined by your surgeon. There is nothing wrong with a saline implant if you have the correct body habitus. I use both saline as well as silicone implants but most females choose silicone because they feel it is more natural and similar to a breast. If you have enough breast tissue coverage then saline works fine below the muscle (never above). I would recommend you seek out a surgeon who gives you both options and decide for yourself along with your surgeon which would be best for you.

Scott R. Brundage, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 27 reviews

Breast implants over or under the muscle

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Thank you for your question. Regardless of the type of implants used, many plastic surgeons, myself included, favor placement of the implants under the muscle. This creates more coverage above the implant, which can limit rippling and make a more gradual transition on to the implant. This is especially true when using saline implants, which have more concerns about rippling to begin with.

In order to place a breast implant above the muscle, there has to be sufficient tissue thickness of your skin, subcutaneous tissue, and breast tissue. This is rarely present in a woman who is a current A cup. I would suggest discussing this fully with your plastic surgeon prior to your augmentation.

Best of luck with your breast augment.

Jeff Rockmore


Under the muscle

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Submuscular implants perform much better long term.  Lower incidence of capsular contracture, malposition, wrinkling and palpability.  Saline or Silicone are reasonable choices. Discuss these choices further with your surgeon.

Location for saline implants

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Saline implants, as well as silicone implants, are fine choices for breast augmentation.  With your decision for saline implants, certainly they will provide a fuller and more rounded appearance, particularly of the upper pole of your breasts.  Recent studies have shown minimal to no change in complication rate for submuscular vs. subglandular placement of implants in terms rupture, infection, capsular contracture, and radiologic imaging of your breast.

So, your final aesthetic outcome is the most determining factor, with all other being equal.  Placement below the muscle will increase your chance of animation (movement) of your breasts/implants with contraction of your chest muscles.  Typically, I would recommend placement of silicone implants below the muscle since there is a little more visibility of saline implants when placed above the muscle.  In general, saline implants have a higher degree of visibility, palpability, and rippling, which is magnified when these implants are placed above the muscle.  Hope that this helps!  Good luck with your decision and I hope for an excellent result for you!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 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.