Are breast implants okay to put over the muscle if your breasts aren't very large?

I'm 18 and came to get breast implants in Rio de Janeiro I came planning to get them under the muscle because I thought they would be best for me from what I've researched. I don't have very large breasts and don't want the implants to be obvious. I don't plan on making them big either. Every doctor I've consulted here with doesn't recommend unders but I'm scared should I say I want unders anyways I'm scared of rippling and the implant being obvious I want to look as natural as possible

Doctor Answers 4

Are breast implants okay to put over the muscle if your breasts aren't very large?

Thank you for your question.  There are many advantages to having the breast implants placed under the muscle.  If you do not have tuberous breast or a constricted inferior pole then under the muscle is a preferable choice.  Placing the implants underneath the breast is a much easier and less time-consuming procedure which may be influencing the surgeons you have visited.  Be sure to consult a  board certified plastic surgeon certified by the American Board of Plastic Surgery and asked for an explanation why implants should not be placed under the muscle.



I generally go dual plane and have at least some partial muscle coverage.  Beware, above the muscle is less expensive because it takes less time to do.  However, if you've had recent weight loss, sometimes above the muscle makes sense if you have some sagging already.

Dr. Barrett

Beverly Hills

Plastic Surgery

Daniel Barrett, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 62 reviews

Submuscular approach in the setting of small native breasts

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons have a preference there are distinct differences to each approach (many of which you have already touched upon).


Subglandular Augmentation/Under the Gland/Over the muscle:

·      Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster when compared to subpectoral augmentation.


·      Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).


·      Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.


·      Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.


Subpectoral Augmentation/Under the muscle:

 ·      Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.


·      Subpectoral implants have a lower rate of capsular contracture.


·      Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion. As you have mentioned, in patients with little native breast tissue, a submuscular approach conceals the implant more effectively.


·      The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.


Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.  Ultimately, you should never be scared to voice your opinion. The key to a successful outcome is good communication. It is not enough to merely be told what the operative plan is, ask your surgeon to explain his/her logic. There may very well be a reason to pursue sub glandular augmentation. It is your surgeon's responsibility to elucidate that reason.

As always, your board certified plastic surgeon can help guide you in your decision making process.

Donovan Rosas, MD
Kissimmee Plastic Surgeon
5.0 out of 5 stars 10 reviews

Are breast implants okay to put over the muscle if your breasts aren't very large?

Thank you for the question. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well. 

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 these sub muscular position.    Best wishes with your upcoming surgery.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.