I am 28 year old mom of 2. I am 5'3", 120 pounds. What will get me the softest: over or under muscle? (Photo)

I am planning on getting 495 allergan cohesive 2 extra full projection. I am wondering what will get me the softest, squishy breast, over or under the muscle?

Doctor Answers 8

Under or over the muscle?

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Implant position

Thank you for the question and the incidence of capsular contracture is generally lower behind the muscle so it is the preferred location for implants.  Also the muscle helps hide the outline of the implant better in thin patients..


Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 59 reviews

Over or under the muscle

You should always go under the muscle as this will provide you protection from capsular contracture as well as to cushion your implant from being palpable especially over the upper breast pole. 

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 44 reviews

What will get me the softest: over or under muscle?

There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:

Subglandular implant benefits:

  • A shorter recovery time.
  • Less discomfort initially.
  • No distortion of the breast when the pectoralis muscle flexes.
  • Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
  • Easier surgical procedure.
  • Larger implants can be placed.

 Subglandular implant disadvantages:

  • The implant may be more visible.
  • More visible rippling, especially in patients with a small amount of natural breast tissue.
  • Higher incidence of capsular contraction.
  • “Bottoming out” in some patients.
  • Some radiologists have more problems reading a mammogram with an implant in front of the muscle.

 Submuscular implant benefits:

  • Usually results in a better appearance for naturally small breasted women
  • Less tendency for seeing ripples of the implant.
  • A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
  • Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
  • Lower rate of capsular contraction.
  • Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.

Submuscular implant disadvantages:

  • Recovery usually takes a little longer and is more uncomfortable initially.
  • There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
  • It is harder to achieve cleavage in women who have widely spaced breasts.
  • The implants often ride higher on the chest.

Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.

The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach.

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.  

Robert Singer, MD  FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  

Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Achieving softness for breast augmentation

Thank you for your question.

The soft feel of the breast will generally be dependent on the fill of the implant and since you are getting the cohesive silicone implant, that helps substantially. Saline implants will be much more hard like the water balloon, and may generally make the breast feel hard when placed over the muscle, especially when there is less soft-tissue coverage. But to add to the natural feel and look, under the muscle placement of the implant will allow a more squishy breast since the muscle provides additional soft-tissue coverage.

I urge you to consult a board-certified plastic surgeon to learn more about better options for the breast augmentation procedure.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

Cohesive gel implants

are better than saline in terms of characteristics that you seek but there are reasons why some go under and others go over the muscle.  I prefer under the muscle to help minimize risks for contractures and accept the animation that comes with it.  If contractures don't develop, breasts are squishy soft as you seek.  Going over the muscle, risks are greater for contractures and in that scenario, would recommend a textured anatomic gel implant but they are firmer that the smooth round implants and less squishy.  

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Softest breast implant over or under the muscle?

The majority of breast implants these days are placed under the muscle due to benefits of reduced capsule contracture and a more natural outline.  I would also review with your surgeon question of why you are using an extra high profile implant if you want a soft natural look.  Either way, enjoy your results and best wishes,

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

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