Wondering if I Should Have Gotten Over the Muscle Implants Instead, Is it Possible to Switch Placement During Revision?

About 7 mnths ago, i had 410 unders. I was also offered 460 or 510 overs, i really wanted the 460 overs, but i was told my my surgeon they can ripple and see the implant if i bent over etc. Im 5"5 & i am a UK size 6-8, i did not have much muscle tissue. I did want them to look natural but i also wanted big boobs. was only a 32aa to begin with, now i measure a 32f but i dont think that i look at f at all, no way.Would i of looked bigger if i had overs??? And can i still have overs in the future?

Doctor Answers 15

Over the muscle implants not the best

Over the muscle you will thin out the tissue, potentially impair the mammograms, see and feel wrinkles and age in a matronly fashion.  Sometimes a patient just has to accept the limitations their own body places on the result they can have.  Maybe see some other doctors, but be very careful about listening to anybody who says you can have "whatever you want."

Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Wondering if I Should Have Gotten Over the Muscle Implants Instead, Is it Possible to Switch Placement During Revision?

Yes you can always change location of the implants but should you? With an F cup? I know you don't think you look that big,,,but what about your friends?...Boyfriend/Husband? not that other peoples opinions matter in the end...but they do help give us a reference, just like this site...So I would really think about it. Might not be worth the possible problems...

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 45 reviews

Overs or unders

I think you are destined to be "Chasing the Imperfection." Since you are relatively small and want to go relatively large, most of your resulting breast will be comprised of the implant you choose and the characteristics determined in large part by the technique. Each technique and placement has advantages but also unavoidable disadvantages. The further away you get from your natural size, the more undesirable side effects and long-term complications you will potentially face. It is a matter of choosing between the risks you are willing to accept.

Patients should be advised and cautioned about this paradox. The smaller the breast, the more motivated a patient is to have implants, the larger the implant required to achieve the appearance the patient desires, and the more risk of unwanted side effects and complications that patient needs to assume. You can't get everything for nothing.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast revision surgery

The implant position can alway be changed during rervision surgery.  It is better underneath and the size will look no difference. It on top you may see more of the implant shape since you were an AA.I would stay with want ypou have for now until  other issues occur, which they will.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 76 reviews

Big boobs and not happy?

From your description, you are mixing goals, facts, and myth. 

First it is possible to switch from under to over in implant placement, in general.  Putting an implant over may make the same size look a bit larger, but with an f cup, what more do you really need?  Since you didn't really have great muscles to begin with, how much difference will it make.

Placing implants over the muscle, especially that large, will greatly increase your chances of sagging, rippling, palpability, and contractures, and ptosis- all bad things.  They will look far from natural, and likely unaesthetic.

Why do I ask?  You will have trouble with clothing fit, may have back trouble, you will be out of proportion and won't be able to "dress them down", and you will stretch your tissue making future revisions (and count on them) difficult or impossible to get a good result.

It sounds like you are going for size only.  My recommendation is to quit while you are ahead, and before you get into trouble.  You will likely find someone to do what you want, but run from him- my advice

Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.8 out of 5 stars 106 reviews

Over versus Under the muscle and Switching Placement During Revision

The advantages of going under the pectoral muscle include:  less rippling, more natural (welllll... depending on the implant size too!), easier to read mammograms, as well as decrease rate of capsule contracture (which is hardening of tissue around the implant).  I believe that based on your size, height, and aesthetic goal, that the choice you made with your surgeon is pretty reasonable.  I would caution against switching to above the muscle, because:  it's more surgery with the risks involved, more rippling, less natural, harder to read mammograms, increased encapsulation, and.....the larger the implant and the thinner the tissue, the more the risk of sagging which we women usually H A T E - wouldn't you??  You can go bigger, but I so agree that you have to be careful of what you wish for - seek the advice of an ethical Board Certifed Plastic Surgeon and don't be afraid to go with some trusted friends or family members - they will usually help you avoid being led down the wrong path.  Maybe it would have looked bigger over the muscle, but the disadvantages outnumber the larger size - bigger is not necessarily better, it's just bigger.

Ghada Y. Afifi, MD, FACS
Orange County Plastic Surgeon
4.3 out of 5 stars 51 reviews

Over or under implants

The size will not change over or under, but what may happen over especially if you are very thin is that the implants may show more rippling.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Should I Reposition My Implants Above The Muscle?

Dear Katiej83,  The key obtaining a "natural" look with breast implants is to camouflage the implants to make them look as breast-like as possible.  In someone who is thin, and from your description, you are, and lacking fullness in the upper breast, then plastic surgeons will commonly place the implants under the pectoralis major muscle to hide the implant edges and to minimize visible ripples and puckering in the upper breast.  If you move your implants from under the muscle and under the breast, given your breast dynamics, i would worry about increased rippling, puckering, and visibility; something very difficult to hide even in clothing.

The difference in breast size between a 410cc and a 460cc implant is quite small and unlikely to increase your cup size.

It appears your plastic surgeon was taking all of these points into consideration when they performed your surgery.  Lastly, please read Dr. Rand's excellent answer before you consider revising your breast implants.

Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 84 reviews

Be Careful What You Wish For....

Hi there-

If your corner of the world is like mine, you will find that if you waive a bit of money in the air, you will find someone willing to do whatever you want...

On the other hand, you should realize that just because someone is willing to do it on you doesn't mean that it is in your best interests, or even advisable.

There should be no appearance based reason that implants placed over your muscles would be an improvement relative to their current pocket. Furthermore, placing them above your muscle will significantly complicate your long term experience and appearance.

If you want larger breasts that's one thing, but placing them above your muscle is likely to be something you'll regret.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 159 reviews

Over vs. Under the muscle placement

This is a debatable topic.  If you were my patient, your  breasts were AA, there is no question that I would strongly recommend submuscular placement and strongly discourage subglandular placement.  Additionally, you may change from under to over but keep in mind that every time you have surgery you are subject to all the complications all over again. Furthermore, closing one pocket to create another can create complications within itself.  

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 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.