I Am Seeking Breast Augmentation Am I a Candidate for over or Under the Muscle?

I am woundering if I am a candidate for implants over or under the muscle. I don't really have any preferences, just wanted to know if I have enough breast tissue to cover maybe approx 350 to 400 cc silicone gel implant. I workout everyday at the gym with weights, I am not a "heavy bodybuilder" but fit. Is it safe to travel on a plane for 3 to 4 hours after 6 days of surgery? I am shopping for the best doctor-even if I have to travel a little.

Doctor Answers 19

I am seeking breast augmentation. Am I a candidate for over or under the muscle?

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. You appear to be an excellent candidate!  Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. 

Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen in correctable problem later.

In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement.

Hope me that this helps! Best wishes for a wonderful result!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Over/Under Muscle: Breast Augmentation

Thanks for the photos.  These days most patients have their implants placed in a sub-pectoral position (under the muscle).  Going under the muscle, decreases the risks of capsular contracture, are better for mammograms and give a softer more natural look.  As for flying, I would recommend waiting at least one week but you should make sure you discuss your plans with your surgeon.

Andrew Smith, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 20 reviews

Breast augmentation, over versus under the muscle

Here in the US, more plastic surgeons place implants partially below the pectorals major muscle than above it. But above the muscle can work quite well too. It depends on so many factors. In my experience, implants placed above the muscle tend to result in breasts that look a bit lower over time than when implants are placed below the muscle. That's not true in every case, but just a general observation. I personally think that pain and healing in general are about the same no matter if the implants are above or below the muscle. The primary determining factor is the technique the surgeon uses and how the tissues are handled and manipulated during surgery. We have done breast augmentation on patients from California, New York, and even Canada, so I don't find that travel is too much of an issue. There are some restrictions, of course, and travel could become a hassle if problems arise. If you plan to travel make sure you discuss this with your surgeon long before your surgery.

Kelly R. Kunkel, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 30 reviews

Breast Augmentation - Muscle Coverage

Submuscluar placement of breast implants has many advantages.  There is better coverage of implants reducing palpable and visual implant rippling.  Capsular contracture ( hardening) is reduced.  In addition, there is advantages when undergoing mammograms.

Craig Mezrow, MS, MD, FACS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 17 reviews

Implants over or under muscle

I generally place implants sub-pectoral- partially under the chest muscle.  Implants usually look more natural in this position.  Additional benefits are that the rate of capsular contracture is lower and mammograms are easier to do when implants are under the muscle.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 16 reviews

Under vs over


thanks for the post and the pics. Generally, here in the US, most are done UNDER the muscle. The under approach is more painful, more expensive, and generally takes longer to heal. So why do it? because in the long run, the results are generally more natural looking and have lower complication rates.

Overseas in Europe and South america, it is generally more common to see these done OVER the muscle. 

Generally, I don't advise flying for at least a week after surgery. No sports for about a month afterwards. 

You should look locally first before flying for surgery. Good follow up care is just as important as the day of surgery for achieving a good outcome. In case there are any complications, which are rare, you want to be able to drive to your doctors office, and not have to fly there. 

Best to you. 



Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 21 reviews

Breast Implant Placement

You have enough breast tissue to cover a 350 to 400cc silicone implant. With silicone gel implants and a healthy upper breast (as determined by calipers during your examination), I usually recommend placement above the muscle. With sufficient tissue and the viscous quality of the silicone, there is minimal risk of rippling and significantly less pain when implants are placed above the muscle. Furthermore, the implants do not "twitch" during exercise as they do when placed under the muscle.

Chen Lee, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast augmentation

You look like a good candidate for breast augmentation. It looks like from the profile that you have some gland/skin ptosis.  The implant volume you selected may be appropriate for you, but an exam is key.  A circumareola procedure may improve the laxity of the skin below as well.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast implants over or under the muscle?!?!

Dear French Lady, 

Merci pour la question et la photo, 

It appears you are a candidate for both over or under the muscle. As listed here by other surgeons there are pros and cons to each. 

I recommend going over the muscle when someone is active and has enough breast tissue to cover the implant because the breasts are naturally above the muscle. Another reason being that the continued muscle contraction pushes the implants down and out to the side with time, which may result in bottoming out, since the muscle does not extend to support the lower part of the breast.

Rippling can be minimized with textured cohesive gel silicone implants because they are form stable.

Traveling one week after surgery should be fine.

Best of luck...

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 68 reviews

Cosmetic Surgery is an Art and a Science

Thank you for the question. Generally, I advise patients on implants behind the muscle. If you choose a gel implant it makes sense to place this above the muscle as your breasts are long. Discuss these options with your surgeon Thomas Narsete, M.D. Austin, Tx

Thomas A. Narsete, MD
Denver Plastic Surgeon
5.0 out of 5 stars 10 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.