Over or under muscle? Very conflicted (Photo)

I am having a BA this Friday, I want to try and get as many opinions as I can before my surgery. I am 24, 5'7, 140 pounds, and I lost 50 pounds 2 years ago which caused my breasts to get smaller. I am conflicted as weather to go over or under the muscle, my surgeon recommend over to get the results I want. Thoughts? I have attached my own pictures as well as my "wish" picture of what I would love for my breasts to look like!

Doctor Answers 14

Implant placement

This is not a question that can really be answered online. It requires an in person exam. In general, I prefer under the muscle, but assuming that you trust your surgeon, I would trust his or her advise. Best, Dr. Nazarian

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Over or under muscle? Very conflicted

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body. Once we determine that we can choose the profile based on what you want or need to achieve.

Implants under the muscle, there is less risk of capsular contracture. Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews


It is very difficult to determine the exact size and shape implant you will require, and  over or under the muscle to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below:

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Above or below muscle

 In most cases, I recommend under the muscle.  In your case above the muscle may be a better option because your breasts sag a bit.  The best result would be for you to get a lift and implants, however.  Have you discussed a lot with your surgeon?

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Above or below the muscle

My guess is your surgeon is recommending over the muscle because you are not having a lift at the same time. I do believe optimal results for you would be a breast lift and implants. There are a lot of advantages to placing the implants below the muscle but in the end, either can be acceptable. I wouldn't recommend under the muscle if you aren't having a lift. Best of luck

Josh Olson MD

Josh Olson, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 90 reviews



If your Plastic Surgeon found that you had sufficient breast tissue and fat in the upper chest to camouflage a subglandular implant, then they may have recommended this placement to provide a slight lift. If you do not wish to consider a breast lift procedure, this approach can  create a perkier look for the breasts, however it is not a replacement for a breast lift when truly needed.

The best breast implants to use for a perkier result contain silicone gel that is more cohesive, such as the Allergan Inspira Truform 2 (formerly known as Soft-Touch gel). These implants are slightly firmer to maintain their shape better, but still retain their natural feel.

Talk to your Plastic Surgeon about the reasons for their recommendation and ensure that you are on the same page before proceeding.

All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Over or under muscle?

In my Beverly Hills practice I recommend to patients similar to you partial subpectoral placement of silicone implants combined with a Benelli (or periareolar) mastopexy to narrow your areolae and raise your nipples.  Placement of large implants alond is ill-advised in my opinion.
Good luck and enjoy your results.  Jon Perlman MD FACS

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews


because of the amount of weight you have lost I worry about the elasticity of the skin.  I fear you will have more ptosis than you want afterwards.  however if the result you want is based on being in a well supported bathing suit, you may be ok

Jonathan Saunders, MD
Newark Plastic Surgeon
4.7 out of 5 stars 64 reviews

Under or over the muscle breast augmentation- Neither! Think Subfascial!!!

The big problem with under the muscle or Dual-plane breast augmentation in your case is that this technique will amplify the separated appearance of your breasts and look very unnatural and positioned to the side.  Sub glandular in a good surgeons hands may be slightly better but the sub glandular plane has no strength thus its power to shape is also limited.  This is why many surgeons have discovered that the subfascial plane overcomes the disadvantages of sub muscular and sub glandular and has many advantages.  The pectoral fascis is a strong tissue layer overlying the pectorals muscle.  If it is dissceted properly, it has the power to shape the breast and create beautiful natural appearing cleavage.  This is why I use a technique called "Cold-Subfascial Breast Augmentation that uses the fascia like a support bra inside the breast.  When patients that have had sub muscular augmentations are unhappy with the separation/displacement to the side I revise them to the Cold-Subfascial Plane.  Look into surgeons comfortable with the subfascial plane and evaluate their results.  I hope this helps!

All the best,

Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Physician
4.9 out of 5 stars 75 reviews

Over or Under the muscle?

Good Question. In general, the benefits of submuscular breast implant placement are: Better superior (upper) coverage/hiding the implant in your cleavage where you will show them off the most Much lower rates of capsular contracture or scar tissue build up around the implant Most importantly, breast implants under the muscle do not interfere with your mammogram, I do not believe there to be any lasting benefit of subglandular (or sub fascial) placement. If your breasts are entirely below the muscle he will recommend a mastopexy (lift), not subglandular placement, to take advantage of the benefits mentioned above regarding submuscular implants. A submuscular implant looks better, feels softer for longer and doesn’t interfere with mammograms, giving you the best chance at early breast cancer detection and highest cure rate should it develop. However, it’s not always that simple. Many times the bottom edge of the pectoralis major muscle ends higher than your natural breast crease. If the placement of breast implants lies completely under the muscle it “rides high” and delivers a less than ideal aesthetic result, with your natural breast “falling off” the front of the implant. Therefore, to prevent that, I frequently utilizes a dual plane implant placement. This means as much of the upper portion of the submuscular implant is under the muscle, for all the reasons listed above, but a small portion of the implant “peeks” out from under the muscle so the implant is nearly centered under the nipple. There are different degrees of dual plane release (I, II, III) but I will do as little a release as possible to achieve an optimal aesthetic result, thereby leaving maximum muscle coverage. With that being said, please understand that breast implants alone simply add volume to your breasts. They do not lift or shape your breasts. If you are happy with the look of your breasts and just want them to be a bit fuller then a breast augmentation alone may work, if not then I would suggest a lift. Please note that attempting to avoid a lift by using an extremely large, high or extra high profile implant is a nothing more than a short term Band-Aid, and does not address the root cause/problem (i.e. stretched/lax and excess skin/tissue). This does nothing but postpones the lift for a short period of time and will only lead to further tissue stretch and thinning requiring an even larger lift to fix. Best Of Luck #DrFeldman #plasticsurgery #SurgarLandTX #HoustonTX

Evan Feldman, MD, FACS
Texas Plastic Surgeon
5.0 out of 5 stars 87 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.