Under or over the muscle implant placement - which would be best for someone who surfs?

Generally if you are an active person it is your safest bet to go on top of the muscle. Why take the risk of the implant displacing? There are many different silicone styles of implants now that we recommend putting on top of the muscle because they are precision filled and do not cause wrinkling. If natural looking is what you are worried about, we go with a natural style implant as oppose on that is less natural.

Dear Eclectic223178,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and profile implants. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful. There is always the possibility that the implants might be seen or felt on the side of the breast or under the breast where there is little or no muscle. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

When implants are placed underneath the muscle, the origin of the pectoralis major muscle from the 6th & 7th rib is often taken down and this will weaken the strength of the muscle. Also, in the retro-pectoral position, contraction of the muscle extrudes the implant inferiorly and laterally and this commonly leads to implant displacement and a revision is needed. When implants are placed in front of the muscle, it often cuts the nerve supply to the nipple and decreased sensation is the result. Also, in front of the muscle, the only thing holding up the implant is the skin envelope and often times the skin envelope is quite thin and rippling can occur and can be visible. Unfortunately, you have not provided photographs. However, you may benefit more from a lift with fat transfers rather than implants.

Best Wishes,

Gary Horndeski, M.D.

For someone who surfs, under-the-muscle (submuscular) implant placement is generally a better choice. Here’s why:
1. More Natural Look and Feel: Placing implants under the muscle allows the chest muscles to cover the implant better, which can create a more natural contour, especially in active movements like paddling.
2. Reduced Risk of Implant Visibility and Rippling: Since surfing often requires intense upper body movement, having the implant under the muscle helps reduce the visibility and rippling effect that can occur with over-the-muscle implants.
3. Long-Term Stability: Under-the-muscle placement offers more support for the implant, which can prevent it from shifting, an advantage in high-impact activities like surfing.
4. Lower Interference with Pectoral Muscles: For someone who uses their pectoral muscles regularly, such as a surfer, this placement minimizes interference with muscle function and reduces the risk of complications like animation deformity, where the implants move unnaturally with muscle contractions.
There are a few downsides, such as a potentially longer recovery time, but for someone with an active lifestyle, submuscular implants are usually the preferred choice. Consulting a board-certified plastic surgeon who understands your lifestyle can give you the best guidance on implant placement.

You did not post photos, which would have been very helpful. with little breast tissue, I usually recommend going behind the muscle for better coverage and support and less sag potential in the future.

I think most plastic surgeons would recommend placing breast implants under the pectoralis muscle.
There are a lot of advantages to putting the implant under the muscle.
The main disadvantage is that the implant moves slightly when you contract the pectoralis muscle.
The main advantage for putting the implant above the pectoralis muscle is that it’s a far Simpler operation from a technical perspective. it also doesn’t have the implant movement from contracting the pectoralis muscle.
Make sure you have a clear understanding if you need a breast lift or not.
If you need a breast lift, then most likely the implant needs to go under the pectoralis muscle.
Some plastic surgeons are big fans of putting the implant above the muscle and will give you lots of reasons why that is better.
Honestly I think the reason plastic surgeons recommend that approach is because it’s technically easy and they could minimize their revision rates by doing an easier procedure.
The plastic surgeons I have known who’ve had busy breast augmentation practices, all place implants under the pectoralis muscle.
It’s not wrong to put the implant above the muscle.
My best recommendation is your focus your efforts on finding the best surgeon and then simply go with their recommendation.
Finding the right plastic surgeon is not at all easy or straightforward.
Simply looking at before and after pictures really doesn’t tell you enough.
Most patients are unable to decipher who is a good candidate for breast augmentation.
Since patient candidacy has a lot to do with what the final outcome looks like this needs to be taken into consideration when reviewing results.
Generally speaking breast augmentation results are based on three variables.
The first variable is the patients candidacy for the procedure.
Issues that can change someone’s candidacy include nipple position, breast position on the chest wall, breast divergence, breast diameter etc., etc.
The second variable is implant selection in regards to size shape and type.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some plastic surgeons do this better than others.
During consultations take care full notes regarding how each provider guides you through the implant election process and who you think does a better job at it.
Make note of how much time and effort is spent simply discussing implant selection.
The third variable is the ability to put the implant in the correct anatomic location.
This is irrelevant of if the implant is placed above or below the pectoralis muscle.
Using excessively large implants tends to always increase the chance of undesirable side effects, increased complication rates, and definitely increases long-term revision rates.
Using modest size implants that fit in your natural breast, anatomy is key for long-term high-quality outcomes.
I suggest patients select a surgeon only after having had multiple in person consultations with board-certified plastic surgeons in your community.
Bring pictures of your breast taken the same way plastic surgeons take before and after pictures.
Use those pictures as reference when reviewing before, and after pictures.
Do not rely on memory or looking in mirrors of What your breast look like.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who have very similar body characteristics to your own.
Ideally, Haily experience provider should have what seems like an endless collection of quality before and after pictures preferably of patients whose breast look just like yours.
Take note of both the quantity and quality of before and after pictures.
Ask each provider what their most common reason is for doing revision surgery.
Ask each provider what their revision rate is and what their revision policy is.
Revision surgery is fairly common after breast augmentation and all plastic surgeons have a certain revision rate.
Claiming to have a low revision rate is not necessarily desirable.
Not offering revision surgery when the revision is indicated means leaving patients with less than ideal outcomes. Having excessively high revision rates likewise it’s also not ideal.
Typical breast augmentation revision rates probably hover around 20%.
Revision rates are highly correlated with implant size.
There’s one single complication requiring revision surgery you want to avoid is implants that bottom out.
Ask your provider specifically how often they have to do revision work for implants that “bottom out”.
When implants bottom out, it means the surgeon failed to create a sufficiently secure pocket to hold the implant in place. It is a failure of the third variable(see above)
The ability of the surgeon to put the implant in the correct anatomic location.
There are a lot of things to discuss during a breast augmentation consultation.
A thorough consultation that truly reviews all the information you need to know should probably take around an hour.
You should leave the consultation, knowing what happens when implants fail, the most common reasons for having revisions, what your surgeons revision policy is, and having a clear understanding of the difference between silicone and saline implants and much much more.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the more likely or to find the better provider for your needs.
The biggest mistake I see patients make scheduling only one consultation and then scheduling surgery.
Having only one consultation, more or less eliminates the ability to choose a better provider.
I do not think patients do a very good job at selecting plastic surgeons.
I also don’t believe You can adequately choose a provider without having a proper in person consultation first.
Some plastic surgeons ask patients to make the final decision regarding implant shape and size.
Other providers will make the final decision based on input from the patient.
My personal preference is to make the decision during surgery based on reviewing lots of before and after pictures.
Once I have a good understanding of what the patient is hoping to achieve I bring appropriate matching before and after pictures with me to surgery.
During surgery, I use temporary sizers to help decide what implants will give the desired outcome.
I generally have a full selection of implants available to choose from during surgery.
From my experience, I found this to be the most accurate way to choose the best implants.
As I mentioned earlier, different providers have different ways of doing this and some providers do it better than others.
Good luck,
Mats Hagstrom MD