Will over the Muscle Saline Breast Implants Look Natural?

I am naturally a 34B and am getting Saline breast implants. The doctor says I have enough breast tissue to go over the muscle, but I'm just not as familiar with it.

Will they look as natural as going under the muscle?

Doctor Answers 8

Breast Implant Position: Over vs Under the Muscle

Saline implants can be placed either under the muscle or above. When the implants are placed under the muscle they tend to give a more natural appearance because there is more tissue covering them. However, in someone who has an adequate amount of breast tissue to begin with, it is absolutely fine to place the implants above the muscle and anticipate a very natural result

Implant position

Decidiing on the pocket location for implant placement really depends upon the anatomy.  I prefer under the muscle in most patients to add more soft tissue coverage.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Appearance of Saline Breast Implants Placed over the Muscle

Saline breast implants can be placed either above the pectoralis muscle or below it. Even when the implant is considered under the muscle, the bottom 1/3 of the implant is truly not under the muscle and the entire outside of the implant is only under the breast tissue itself. That is where patients complain of the rippling and palpability of the implant after a saline breast augmentation if they are very thin or have very little breast tissue. Saline implants can be placed above the muscle in situations where the patient has a good amount of soft tissue (either breast or fat) at the top of the breast. I use a caliper to pinch the tissue in the top portion of the breast to best assess this. Addtionally, when the implant is placed above the muscle, I usually lift up the thick coating over the muscle called the fascia. This allows for additional coverage of the implant at the top and medially near the sternum. This helps cut down on an unnatural appearance and rippliing. There are benefits of being in this "subfascial" plane rather than under the muscle. The 2 biggest are that the implant will not move and possible distort the breast with contraction of the muscle and second the initial surgery is less painful with an easier recovery. Your consultation with your surgeon will best help assess which pocket and size of implant would be best for you.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.5 out of 5 stars 47 reviews

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Breast implants over the muscle.


It really depends on the details of your anatomy.  In New York, we do occasionally place saline breast implants over the muscle in selected patients, and they look natural.

You need to trust your surgeon.  Get another opinion if you are not sure

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Will over the muscle Saline breast implants look natural?

Maybe or maybe not. I prefer to use saline implants but do put them under the muscle.

Looking natural depends a great deal on your expectations. Then, there is the amount of breast tissue - you and your doctor are OK with this - and the amount of subcutaneous fat. If you have "enough" of the above, then you should be OK with above the muscle placement. It is less painful after surgery - that's a plus vs putting the implant under the muscle. "Rippling" of the implant can be minimized to a degree with a maximum fill of the implant.

If your not familiar with the treatment plan, you should talk with your doctor again or at a minimum, see another doctor.

Michael Kulick, MD
San Francisco Plastic Surgeon
2.5 out of 5 stars 3 reviews

Saline Implants over the Muscle

Saline implants placed btween the breast and underlying muscle have the greatest chance of appearing abnormal. Saline implants have a higher rate of wrinkling. If they are placed under the muscle, the muscle can hide the wrinkling somewhat. I think that you would probably be happiest with silicone implants placed under the muscle. If you have concerns, you should address these with your surgeon.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Naturalness of appearance will depend on your tissue

In the United States the majority of saline implants are placed beneath the pectoral muscle. Saline implants, which tend to wrinkle or ripple a bit more than traditional gel devices look more natural with more of your native tissue covering them.

Your surgeon will assess the thickness of your natural tissues, and if considering above the muscle the thickness in the upper portion of the breast seems most critical to a natural result. in patients that are thin up top, the extra layer of tissue provided by the pectoral muscle helps camouflage the transition from your upper chest to the upper edge of the implant

If you are unclear on the reason for the suggestion for that location go back for another visit. If still unclear you may want to seek another opinion.

John E. Gross, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

I generally prefer smooth implants placed under the muscle.

I generally prefer smooth implants placed under the muscle using an incision around the areola or under the breast.   Reasons are:

1)more tissue covering the implant for a more natural look.

2) improved mammograms when compared to the subglandular implants.

3) decreased rate of capsular contracture. I reserve the textured implants for patients with capsular contracture or in patients with significant breast tissue and ptosis requiring a subglandular placement.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 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.