Best Option for Breast Enlargement?

I am currently seeking advice for a BA. I am 157cm 48kg have minimal breast tissue after having 3 children. I have seen 2 plastic surgeons both whom have given me 2 different opinions on the type of procedure would suit me best. Surgeon 1 says they would place the inplants behind the muscle as I am so small, and feels I am at risk of rippling. Surgeon 2 says no definately in front of muscle, that I have enough breast tissue, behind muscles causes too many complications. Which advice do I trust?

Doctor Answers 6

Slender, Small Breasted Women Do Better With Implants Below The Muscle

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With minimal breast tissue and being very petite, I  would strongly recommend your breast implant go below the muscle.  The implants statistically have a better chance of staying soft, you will get a better mammogram, less chance of seeing the edge of the implant, and less chance of rippling.  I am concerned about plastic surgeon #2.  The comments you attribute to him or her do not sound to me like a Board Certified Plastic Surgeon. 

When choosing a surgeon to do your breast augmentation, be sure that the surgeon you choose is Board Certified by the American Board of Plastic Surgery.  Be sure they have privileges to do a breast augmentation at a local hospital, and be sure that your surgeon has a great deal of experience in breast augmentations.  Look at before and after pictures and speak to at least two of each surgeon's patients.  With reference to Surgeon #2, ask for two patients who have implants above the muscle and see if they are happy with their results. 

Best Placement of Breast Implants

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The placement of implants can be done safely both above and below the muscle. If the skin at the upper pole of the breast is thicker than 2 cm, implants can be placed above the muscle with positive results. If the skin is thinner than 2 cm, an implant under the muscle will produce better results. The majority of my cases have been under the muscle and these patients are happy with their results. When choosing a plastic surgeon, be sure to find someone who has a board certification and is very experienced in breast augmentation.


Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

Submuscular vs. Subglandular Breast Implant Position

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Thank you for your question.

I would highly suggest that you make sure that the surgeons you are visiting with are board certified plastic surgeons.  You can get more information on the ASPS website regarding board certification.

Both positions have pro's and con's but I believe that most board certified plastic surgeons place implants in the submuscular position for better, longer lasting breast augmentation results.

Although breast implants in the sub muscular ( or dual plane)  position may experience “distortion” with muscle movement (workout) I still think it is in most patients best interest seeking breast augmentation surgery to have implants placed in the “dual plane” 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 in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this is helpful.

Under or over the muscle in breast augmentation

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This is a confusing area, as there is usually no right and wrong answer.  Surgeon preference, patient preference, the size you want to be and your natural anatomy are the factors which influence the recommendation of the surgeon.

Each plane has its pros and cons. Essentially, the thinner you are the more the decision matters. At 48kg you are thin, and if you have very little breast tissue then it's more likely you'd be better to have the implants under the muscle.  However, without examining you it's not possible to make a firm recommendation.

Sorry to not offer direct advice, but without pictures and an examination of your physique it's not possible to offer a specific recommendation.


Good luck.

Breast Augmentation placement

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For starters, be sure you are consulting with a Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgeons (ASPS).  That's the first thing.  Some surgeons call themselves Plastic Surgeons, and are not certified by the only recognized board.  Be sure to ask if you need a lift at the same time as the Breast Augmentation.  Without seeing pictures of you, I cannot recommend the placement. Best of luck with your surgery.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Above or below the muscle?

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Most surgeons in the US prefer placing breast implants behind the pectoralis muscle. The advantages of having more of your own tissue covering the implants is less rippling, and less chance of capsular contracture. There also may be a more natural appearance since the upper pole of the implants blends into the chest wall better when the implant is under the muscle in the slender patient.

The main disadvantage is "animation," or movement of the implant when the pectoral muscle is flexed. Most surgeons ignored this as a "complication" until recent years. In the US, the submuscular position is the default. When there is a good reason to consider placing implants above the muscle, I use several criteria:

  • Adequate breast tissue to cover, and this I can't easily define, or even guess for you without seeing photos
  • Upper pole of the breast thickness of at least 2.5 cm
  • Patient chooses silicone implants.
  • Patient accepting higher risk of capsular contracture and ripples.


Without seeing photos I wouldn't try to second guess either consultant. I would suggest additional opinions by surgeons in your area.

Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.