I'm 5'4, 110 lbs 32 DD, Subpectoral placement on thin people with large breasts. Any suggestions? (photos)

I understand that sub pectoral placement of the implant is the most popular method used by surgeons and is recommended for thin people - however, what about thin people with already large breasts and slightly sagging skin? I am not interested in a lift, just more volume. I am afraid of the muscle deformation effect and the appearance of "breast on top of breast" issue with subpectoral implants. My friend has this done and you can see her natural breasts on top of implant when she bends down.

Doctor Answers 7

Need more volume

Thank you for your question and photo. Placement of breast implants below the muscle is the preferred plane for most women. However, it is not always the best choice for all women. As you noted, implants below the muscle will distort with flexion of the pectoralis muscle. Not a great thing for body builders or fitness models. Placement above the muscle can help fill loose breast skin and give a fuller appearing breast in a breast that may be slightly droopy. The effect, however, is temporary. Over time the weight of the implant will cause drooping or ptosis of the breast and may require a breast lift down the road. Placing an implant behind the muscle of a ptotic or droopy breast will create the appearance of the breast "falling off the implant". Again not a good look. For women with this situation, a breast lift along with the implant is warranted. 

So, having said all that, the most important thing is to sit down with a Board Certified Plastic Surgeon and explain what your goals are. The best operation is the best operation for you!  

Best wishes and Good luck!

Implants, some advices:

Thanks for the question.

I recommend you Cohesive Gel - Silicone Breast Implants with textured cover ("gummy bear implants".
They are quite safe and aesthetically best as they give a firmer consistency, better projection and most natural appearance than Saline implants.
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 138 reviews

Breast augmentation

Hello and thank you for your question. You are a good candidate for a breast augmentation with a dual technique for implant placement.  This can solve many of the issues you worry about.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  This entire surgery can be performed with a small incision technique.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 60 reviews

I'm 5'4", 110 lb, 32DD, subpectoral placement on thin people with large breasts. Any suggestions?

Based upon your photograph, you would be a good candidate for a "dual plane" (or "split muscle") breast augmentation.  Using this method, the upper portion of the implant is placed behind the muscle, providing camouflage and potentially decreasing capsular contracture rates, while the lower portion of the implant is placed on top of the muscle, allowing the implant to settle into the natural breast, resulting in a more natural contour to the lower portion of the breast.  You should not require a breast lift.

I would recommend that you consult with board-certified plastic surgeons experienced in breast augmentation (and "dual plane" implant placement) to determine the best way to achieve your desired outcome.

Best wishes.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 25 reviews

Breast augmentation

You have some very valid concerns. I think this is best addressed on your consultation. Be sure you are picking a board certified plastic surgeon. There are pluses and minuses to the various techniques. You and your doctor can talk about the best option for you.

Tracy E. McCall, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 1 review

Implant Placement


The best way to determine what your options are is to meet with you in person. Your Plastic Surgeon will examine your breast tissue and take careful measurements. When the degree of sagging is too much a breast lift is usually necessary to remove excess skin, elevate the position of the areolas and reduce the risk of unpleasant results. If placing implants without a lift a fuller implant, over the muscle will often be used.  I recommend that you book a consultation with a board certified Plastic Surgeon who specializes in these procedures.

All the best 

I'm 5'4, 110 lbs 32 DD, Subpectoral placement on thin people with large breasts. Any suggestions?

Even though you are somewhat low and a lift would be indicated - a sub-glandular implant - that is over the muscle and not under it- could be done for you. This position of the implant will enhance your already present volume without any muscle disruption. 

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.