Are breast implants over the muscle an option for me? (Photos)

Question

Hi, Is there any chance I could get implants over the muscle based on my photos? I have breastfed two children. Under the muscle is a treshold question for me. Aiming for a natural enhancement with +/- 200cc implants. Thank you!

Mert Demirel, MD · Answer

The honest answer is: possibly, yes &mdash; but it depends on one key measurement. Over-the-muscle placement works well when there is enough natural breast tissue to cover the implant, because in this position the implant has no muscle over it and relies entirely on your own tissue for camouflage. In slimmer patients with modest breast volume, the risk is that the implant's edges become visible or palpable over time, especially in the upper part of the breast and the cleavage area. This is checked with a simple examination &mdash; how much tissue can be gathered at the top of the breast &mdash; and that measurement, more than anything else, determines whether over-the-muscle is a safe choice for you.There are several things working in your favor. Your goal is a natural enhancement with a moderate size around 200 cc &mdash; and smaller, appropriately chosen implants are much more forgiving over the muscle than large ones. Having breastfed two children also matters in a positive way here: the breast envelope is often slightly softer and more accommodating, which can help the implant blend naturally. And if the examination shows your tissue coverage is borderline, there are good solutions that still respect your "no muscle" preference &mdash; such as choosing a cohesive implant with a lower risk of visible rippling, or a hybrid approach where a small amount of fat is added over the implant to thicken the coverage. So under-the-muscle is not the only path to a natural result.The most suitable next step would be an in-person consultation with a board-certified plastic surgeon experienced in post–weight loss body contouring. During a physical examination, your skin quality, the areas of looseness on your abdomen and beneath your breasts, and your breast shape can all be properly assessed, and a clear plan can be mapped out &mdash; what to combine, what to stage, and what result you can realistically expect at your current, healthy weight.

Ellen Ozolins, MD · Answer

Thank you for your question. Over-the-muscle implants may be an option, but it depends on how much natural breast tissue and soft tissue coverage you have. Since you have breastfed two children, if you still have a reasonable amount of breast tissue, a small implant (around 200 cc) placed over the muscle can provide a natural result. However, if your tissue is thin, placing the implant under the muscle or in a dual-plane position may better hide the implant edges and reduce the risk of visible rippling, especially in the upper pole. The decision should be based on a pinch test and physical examination, not photos alone. Have an in-person consultation with a board-certified surgeon to determine whether you have enough tissue to safely achieve a natural-looking result with over-the-muscle implants.

Daniel Barrett, MD · Answer

Dear ivanasa,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Banafsheh Sharif-Askary, MD · Answer

Based on what you've shared, yes, placing implants over the muscle could certainly be an option. The biggest factor is something we assess during an in-person examination called upper pole skin thickness, essentially, how much soft tissue you have in the upper part of the breast. This tissue helps camouflage the edge of the implant and creates a smooth, natural transition.
The good news is that implant technology has advanced significantly. Modern implants are designed to look and feel more natural, which has allowed us to safely offer over-the-muscle placement to many women who may not have been considered ideal candidates in the past. With a modest implant size around 200 cc and your goal of a subtle, natural enhancement, over-the-muscle placement may be a very reasonable option if your tissue characteristics are favorable.
Ultimately, the decision depends on your anatomy, tissue quality after breastfeeding, and your aesthetic goals, all of which can only be fully assessed during an examination. But based on what you've described, I don't think over-the-muscle placement should be ruled out.

Christopher T. Maloney Jr., MD · Answer

Placing a breast implant on top of the muscle (over-the-muscle or subglandular placement) offers several potential advantages, depending on your anatomy and goals. In my practice, over the past 6-7 I have changed to mostly subglandular placement for many reasons as long as the patient is a good candidate. 
Advantages
•	Less postoperative pain: Since the chest muscle isn't lifted or divided, recovery is often more comfortable. 
•	Faster recovery: Many people return to normal daily activities sooner than with under-the-muscle placement. 
•	No animation deformity: The implant stays in place when you contract your chest muscles, so it won't move or become distorted during exercise or lifting. 
•	Better for very active people: Weightlifters, swimmers, climbers, and others who rely heavily on their chest muscles may prefer this option because the implant doesn't interfere with muscle function. 
•	Greater upper-pole fullness: Over-the-muscle placement can produce a fuller appearance in the upper part of the breast, if that's the desired aesthetic. 
•	No muscle weakness: The pectoral muscle is left intact, so there is no temporary loss of chest muscle strength related to surgery. 
The best placement depends on your anatomy, implant size and type, skin quality, and aesthetic goals. From your photos and the desired size, subglandular placement appears to be an excellent option. Your plastic surgeon can measure your tissue thickness and help determine which option is most likely to provide a natural-looking result with the lowest risk of complications.

Ira H. Rex III, MD · Answer

Either position is an option for you.  Placement of the implants over the muscle gives you a much higher risk of implant visibility and rippling.  Talk with your plastic surgeon about risks and benefits of either.  In my patients, I would strongly advise placement under the muscle.  Good luck with your surgery.

Yasemin Aydinli, MD · Answer

Subglandular or subfascial placement with ~200cc implants can look very natural when soft-tissue cover is adequate &mdash; the key test is an upper-pole pinch of at least 2cm. If cover is thin, dual-plane gives a similar natural feel with better camouflage.

Arthur Dean Jabs, MD, PhD, FACS · Answer

In my experience going over the muscle is never warranted. I have tried it and found it to be seriously lacking over a longer period of time. When you go over the muscle you are releasing the ligaments that go from the breast to the chest. Thses provide support for breast volume. When you add an implant you place pressure on the skin from it's weight which will eventually stretch the skin causing the breasts to sag. 
My advice is to go under the muscle but be sure the inferior border of the pectoralis is completely released

All the Best,

Dr. J

David Shokrian, MD · Answer

Hello, and thank you for your question. Based on your photos, you appear to have mild volume loss in the upper portion of the breasts following pregnancy and breastfeeding, with what seems to be limited soft tissue coverage. While photographs can provide a general impression, they are not sufficient to determine the ideal implant pocket. Whether an over-the-muscle approach is appropriate depends on factors that can only be evaluated during an examination, including tissue thickness, skin quality, breast dimensions, and your overall anatomy.
With your goal of a subtle enhancement in the range of 200 cc, an over-the-muscle option may be possible if you have adequate tissue to provide implant coverage and support. During an in-person consultation, your doctor should precise measurements, discuss your aesthetic goals, and recommend the implant size, profile, and placement that will provide the most natural-looking result for your anatomy. In my experience, reviewing outcomes in patients with similar measurements can also be very helpful in selecting the implant that best aligns with your expectations. I hope this is helpful as you consider your options. Best wishes as you continue your research and consultation process. 
David Shokrian, MD Plastic & Reconstructive Surgeon

Semih Yildiz, MD, FEBOPRAS · Answer

The photos suggest modest breast volume with some upper-pole deflation and relatively limited soft-tissue coverage, although photos cannot replace measurements and a pinch test. Over-the-muscle placement can look natural in selected patients, especially with a small implant, but it needs enough breast tissue to cover the implant; otherwise visible edges, rippling, and a less natural upper pole become more likely.

With a goal around 200 cc, subglandular or subfascial placement may still be worth discussing if under-the-muscle placement is a firm no for you, but I would not choose the pocket from photos alone. An in-person exam should assess tissue thickness, skin laxity, nipple position, chest width, and implant profile before deciding.

Are breast implants over the muscle an option for me? (Photos)

Answers (14)

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