Over or Under the Muscle?

Hi! I am getting my breast done Jan 23, and i have 5'8 132, and a AA, so pretty small for my height.. My surgeon is saying i should go over the muscle bc i am an avid gym rat and compete in fitness competetions so he said i would have a faster recovery, but everyone i ask says go under the muscle.. like literally everyone!! even friends who compete, what is your advice??

Doctor Answers 6

Over or Under the Muscle?

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular).
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.
I hope this, and the attached link, helps. Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Implant position

is really up to you.  I have 2 champions who have had their implants under the muscle as they have found ways to deal with the muscle movement during their bikini contest.  Yet if the muscle movement will be bothersome, then it should be above the muscle.  Only you can decide what will work best for you but under the muscle has the following advantages: better mammograms, more fullness on top, no rippling on top, and LESS RISK for contractures.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Should your breast implants be over or under the muscle?

Thank you for your important question.  Your concern is a very common one.

There are several advantages to placing the breast implant beneath the muscle most notably a reduced chance of capsular contraction or hardening of the breast implant over time.

However your surgeon has pointed out a common negative which is that when the implant is placed beneath the muscle and you contract the chest muscle during exercise the implants can have visible movement.

However it is up to you to decide whether  this movement will be distressing to you.  Many physically active young woman, even bodybuilders have had implants placed beneath the chest muscle and the motion during their activities  do not bother them.

Recent data strongly suggests that textured breast implants  are less likely to cause capsular contraction.  If you do proceed, be sure to discuss the benefits of a textured implant whether it is placed over or under the muscle.

Over the muscle with Mentor Sitex textured gel implants give most natural looking and feeling breasts

In my practice I find that the best looking and feeling and most natural appearing breast are achieve with peri areolar placement of Mentor Siltex textured gel implants. The limiting factor is the thickness of the upper pole of your breast. If there is not enough soft tissue thickness to cover over the ripples which are present in all breast implants. The textured gel ripple least, smooth wall gel next and saline the highest amount of rippling. If you don't have adequate soft tissue in your upper pole of your breast then a peri areola incision with a textured gel implant place under the breast in the lower half and under the muscle in the upper half, a dual plane works quite well. An incision in the arm pit and an implant placed under the muscle works well but is not as natural. The problem for a gym rat with the implant under the muscle is that the breast becomes distorted when you flex your muscle but other wise is a fine alternativ.  

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breast aug

Thank you for the question.

Every Doctor has it's own opinion, for me the implants look more enhanced with a more natural look when they're placed under the muscle. The recovery with over or under it's still the same, same post op instructions to follow. It really depends on how you want them to look.

Good luck,
Dr. Campos.

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 252 reviews

Breast Implants- Above or Below the Muscle

In general I usually recommend going below the muscle (dual plane placement) for my breast augmentation patients. While it is true that the recovery may be a little faster if the implants are placed above the muscle, the long term results are usually much better if the implants are placed below the muscle. The benefits of going below the muscle are a more natural look as the muscle will give more soft tissue coverage, more accurate mammograms and less chance of capsular contracture. Many of my patients are very athletic and they are able to resume all of their pre-surgery activities once they complete the healing process. Patients that are high level body builders may be better suited to have the implants above the muscle as the implants may displace when posing during competition. This is usually the only scenario I recommend going above the muscle. For 99% of my patients I feel placing the implants below the muscle (dual plane) gives the best long term results. Best of luck for your surgery!

Jeff T. Healy, MD
Oahu Island Plastic Surgeon
5.0 out of 5 stars 104 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.