Will over the Muscle Saline Breast Implants Look Natural?

Question

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?

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts.  Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years.  In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance.  Your breast width is the most important measurement.  Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant.  This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape.  Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width.  Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle).  Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each.  In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome.  A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles.  Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions.  As you see, there are a few factors to decide upon for incision, placement, and implant type/size.    Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.  Hope that this helps! Best wishes for a wonderful result!

Otto Joseph Placik, MD · Answer

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.

Michael Kulick, MD, DDS · Answer

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.

Jeffrey Weinzweig, MD, FACS · Answer

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

Steven Wallach, MD · Answer

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.

Will over the Muscle Saline Breast Implants Look Natural?

Answers (9)

Answer: Breast Implant Position: Over vs Under the Muscle

Answer: Breast Implant Position: Over vs Under the Muscle

Answer: Implant position

Answer: Implant position

Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.

Will over the Muscle Saline Breast Implants Look Natural?

Answers (9)

Answer: Breast Implant Position: Over vs Under the Muscle

Answer: Breast Implant Position: Over vs Under the Muscle

Answer: Implant position

Answer: Implant position

Browse related questions

Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.