I went for a consult today and was told the over the muscle placement was the better option for me, instead of under. Advice?

I do not want the bolt on look and I was wondering if this method with give me a natural look. I'm going from a B to a D.

Doctor Answers 7

Implant position

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Thank you for you question. I would say the vast majority of the time, implants are placed below (under) the pectoralis major muscle. It helps to camouflage the implant better, and may help long term w/ less capsular contracture (debatable). Placing the implant above the muscle (sub-glandular) can be good for women who enjoy extreme fitness, weight lifting, and competitions because the movement of the muscle is less visible. You really need sufficient tissues to cover the implant though. I hope that helps a little in your decision process. Best wishes.

Implant Placement

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thank you for your question. I will typically only advise the sub glandular placement in patients with at least a couple of cm of fat/tissue in the upper pole for camouflage. Your Plastic Surgeon may recommend this approach if you have slight pseudo ptosis/deflation and want to avoid a breast lift procedure. Talk with them about your concerns. My patients find it helpful to try on the implant sizers with a form fitting T-Shirt in the office in order to get a feel for how they will look.

Be sure to seek a board certified Plastic Surgeon who specializes in this area.

All the best  

Above or below the muscle for breast implant placement

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Both above and below the muscle for placement of breast implants can yield excellent results.  The old mantra of all the implants needing to be below the muscle has been dispelled when the new silicone implants came back onto the market in 2006.  The silicone has a more natural feel and wrinkles less than the older saline implants, therefore when they are placed on top of the muscle they look and feel much more natural.  Most of  the reports of results of implants above/under the muscle were based on 14 years of experience with saline implants, not the newer silicone.

If your anatomy is such, do not be afraid to go on top of the muscle, some of my best results are now women that have a nice natural look with silicone implants.  Mammograms can be performed easily and the capsule rate is no greater than under the muscle.  The recovery is quicker and it is less painful.  Your plastic surgeon should be your best source of information on why he/she is choosing this option, don't be afraid to ask why.

Good Luck!

Breast Augmentation

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Under the muscle is the most preferred placement by the vast majority of surgeons. We would need front and side view photos with arms at your sides to make any comments specific to you. 

Implants above or below the muscle

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Thank you for your question. Implant placement depends on your goals and anatomy.   The majority of the time implants are placed beneath the muscle.  Typically implants placed under the muscle have less risk of capsular contracture and rippling than implants placed above the muscle.  Implant selection should be based on the measurements of your breast.  A natural appearance can vary from person to person. Find some goal pictures and get other opinions if you are having doubts.   Good luck.  

Jon E. Rast, MD
Kansas City Plastic Surgeon
5.0 out of 5 stars 35 reviews

#breast implants under or on top

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The most important factor in obtaining a good result from your aesthetic procedure is the surgeon you choose to perform it. 
Most surgeons in the US perform augmentation under the muscle, some, the minority, perform on top of the muscle augmentation.
In my personal experience, I stopped performing on top of the muscle augmentation approximately 14 years ago. The main reason why I stopped doing it was because the longevity of the result is less, patients have earlier sagging of the breasts, specially if relatively large implants are used ( larger than 400 cc). 
In general, the more of your own tissue that cover the implants the better result you will have.
Small implants are usually well tolerated on top of the muscle, but the incidence of capsular contracture is higher on this location, specially if a textured surface implant is not used.
Be sure you seek the advise of a surgeon member of the American Society for Aesthetic Plastic Surgery.
Also be sure you look at long term, more than a year, postoperative pictures of patient similar to your condition.

I went for a consult today and was told the over the muscle placement was the better option for me, instead of under. Advice?

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Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to proceed after surgery. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices. It is quite amazing how adamant each plastic surgeon can be about the superiority of his/her recommendations…

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 the sub muscular position.

I would also suggest that you avoid utilizing cup sizes as a reference when you communicate your goal; remember that a "D cup" may mean different things to different people and therefore be a source of miscommunication.  In my practice, I utilize computer imaging and goal photographs as visual aids to aid with the communication process.

I hope this, and the attached link, helps. Best wishes.

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.