I'm 48, breast fed 3 children. Dr recommending above muscle augmentation. Any pictures or thoughts would be appreciated

Doctor Answers 8

Implant position and lifting

As a general rule I do not like above the muscle placement of breast implants. The main reasons are that the upper pole of the breast is where we lose volume as we age. An implant placed directly under the breast has the potential to cause visible rippling in the upper chest as the breast volume decreases. Secondarily if we look at an implant complication called capsular contracture, it is much more common when implants are placed above the muscle than when they are placed below.

If this is being suggested to avoid a breast lift, I believe that logic is flawed. Skin is not a supporting structure it is a veneer. Once you add weight directly to the skin it will stretch. You may look great immediately after the surgery but 2-3 years down the road you will be more droopy with a subglandular implant. Although the thought of scars may concern you the overall breast aesthetic will be far better and last longer with an implant under the muscle and a lift.

Seek out a board certified plastic surgeon to evaluate you and discuss your options.

Good luck and I hope this was helpful

Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 129 reviews

Where should I have the breast implant placed?

If you have had children, your breasts most likely are droopy. If that is the case, I would suggest at least a small uplift. In that case the implant can be placed in any location. On your free consultation I would listen to what you want to achieve, discuss what can be done and then based on what your breasts look like make recommendations! 

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

Breast implants

My only concern is that the plastic surgeon is placing the implants above the muscle because you have some sagging and you really need a lift with the implant.  That's why seeing some photos would really be helpful.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant position

should be decided by you after being fully informed by your surgeon.  What did your surgeon say that supports the recommendation for above the muscle?  I prefer below the muscle for the following reason... better mammograms, no rippling on top, more fullness on top, and less risk for contractures.  Bad things about under the muscle... movement when flexing your chest muscles (but often more of a twitch rather than distortion) and the inability to completely remove the capsule if you should develop ALCL (3 in 500K).  Above the muscle, you get more drooping with time and lose the benefits mentioned above.  So you should make the decision as to what is best for you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast Augmentation after 3 children

Hello 'lesles', thanks for your question.  Without seeing any of your photos or any other details, it is hard to make an accurate recommendation.  However, I typically never recommend above muscle augmentations due to documented increased risk of certain complications, such as capsular contracture and rippling, not to mention above muscle usually leads to more unnatural looking breasts, especially with thin skin.  Further, with 3 children, if you require a concomitant breast lift, the risks of nipple necrosis goes up with above muscle implant placement.  The rare exception for above muscle augments would be the body-builder who does not want any dissection or alteration of the pectoralis muscle and does not need a lift.  Be sure you seek consultation from a board-certified plastic surgeon and good luck!


Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast Augmentation: Information

Dear Ms. Lesles,
Thank you for your story and questions.

Nothing substitutes for a personal evaluation and a face to face discussion of your options. Many factors need to be taken into consideration than just your desired breast volume. Unfortunately without a exam of your tissue and measurements I can give you general information that I hope you find helpful.

Your final desired breast appearance is a combination of your current breast appearance, size, shape and location of the implant chosen.

There are many decisions both you and your Plastic Surgeon needs to make. 
My answer to your specfic questions are:
1) I in general prefer that implants be placed under the muscle (dual plane) because of the lower incidence of capsular contracture and the coverage the muscle provides.
2)I would advise round silicone gel filled implants (the profile to be determined by your chest measurements: see below)
3)Volume size to be determined as described below
4)the inframammarry incision is associated with lowest rate of post operative capsular contracture.
5) At your preop appt. and on the day of surgery bring several model photos of what you want your final breast appearance to look like.

Your final decision should be based on personal consult with a Bd. Cert. Plastic Surgeon who will examine you and go over that which is best for you. The following are some of the topics you may want to discuss and why.

General overview of your choices and discussion points:
1) normal saline fill vs silicone gel fill
2) profile: low profile to high profile (choice based on chest measurements)
3) shape: form stable vs round

1) sub pectoral, dual plane
+ less chance for internal scarring (capsular contracture)
+ padding from the muscle therefore less chance of implant palpability (rippling)
- varying degree of animation upon pectorals major contraction ( breasts moving)
- longer immediate recovery
2) supra pectoral
+ in borderline ptosis (breast sag) can provide alternative need for mastopexy
+ faster immediate recovery
+ animation upon contraction of pect. muscle is nil
- increase chance of internal scarring (capsular contracture
- increase potential for breast implant palpability (rippling)

1) periarolar
2) inframammary
3) axillary

1) symmetrical
2) equal size
3) breast fold location
1) normal
2) high
3) low
4) symmetrical
5) too large

1) stretch marks
2) thin skin
3) elasticity

is a very personal choice
1)implants come in "cc" sizes not cup sizes
2) 30 cc = 1 ounce
3) purchase a full bodied, non padded bra and take a nylon stocking and fill until you reach the desired size you desire....measure the volume using a measuring cup and convert to cc's.
4) If implants placed under the muscle I usually recommend adding 10% to measured volume to compensate for the flattening affect of the subpectoral placement
I personally choose the company that the breast implant base measurements and match to the patients chest measurements. Sientra only makes Silicone Gel filled implants. Ideal only makes Normal Saline implants (with internal baffles). Allergan and Mentor make both silicone gel and Normal Saline filled implants.

Please bring several model photos of your desired breast appearance and a list of questions to your consultative appointment and make sure your Plastic Surgeon is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

Best wishes,

Dr. R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Robert A. Hardesty, MD, FACS
Riverside Plastic Surgeon
4.8 out of 5 stars 98 reviews

I'm 48, breast fed 3 children. Dr recommending above muscle augmentation. Any pictures or

Thank you for your question. It is difficult to give you an accurate evaluation without photographs but with the knowledge that you had three children and breast-fed them I am assuming that your tissues have thinned and are likely to show the upper edge of an implant placed above the muscle now or in the future.  My recommendation would still be to consider a partial subpectoral placement of a cohesive silicone gel implant possibly accompanied by a limited or full uplift if necessary.We are currently recommending the Inspira implants due to the fill level and the reduced risk of rippling that this may produce.  Having the upper edge covered by your pectoral muscle should be aesthetically valuable and furthermore reduce the risk of capsule contracture.Meet with one or more board-certified ABPS plastic surgeons for a face-to-face exam an evaluation to get the best recommendation for you.

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Placement of Implant


Thank you for your question. Where some deflation and pseudo ptosis is present in the breasts, placing the implant in the sub glandular position can provide a slightly more lifted, perky look. Your Plastic Surgeon will assess to make sure that there is enough breast tissue and fat to provide a natural contour and cover for the implants in this position.

All the best   

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 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.