Should Breast Implants Be Placed Under or over the Muscle?

If you were looking for a more "natural look", I would suggest placing breast implants underneath the muscle. The muscle serves to camouflage the upper part of the breast implant. This leads to a more natural breast shape where the slope of the breast extends in a straight line from the chest wall to the nipple. If you are looking for more fullness in the upper portion of the breast, I would suggest placing the breast implant above the muscle or in a subglandular position. In addition, if you are looking for more breast cleavage, I would suggest placing the breast implants in a subglandular or above the muscle position.

I have put most implants below the muscle: -Less capsular contracture.  3 times less -Better implant coverage, Less wrinkling and palpability.  - Perhaps easier to read mammograms- Better upper pole contour. However, above the muscle:  -Textured implants improve capsular contracture rate-Shaped implants have less wrinkles. - Less chance of abnormal muscle motion. If you decide to go above the muscle, I suggest shaped, textured implants will work better.  

Breast implants can be placed on top of the muscle or under the muscle. One way is not better than the other but there are differences.  Generally, any implant placed under the muscle has less risk of palpability and rippling than an implant placed on top of the muscle.  However, because of the anatomic shape of the pectoralis major muscle, it is still possible to develop palpability and rippling in the lower, outer region of the breast.Thank you for your question,

For most of my patients, placing breast implants below the pectoralis muscle is preferable. Implants placed below the muscle will have the following benefits:

1) Reduced risk of capsular contracture

2) Reduced risk of infection

3) Reduced risk of implant exposure

4) More natural appearance; especially on the upper portion of the breast.

It is important to realized that implants placed below the muscle, are mostly below the muscle...not completely below the muscle. In almost all women, there is no definable pectoralis muscle underlying the lower outer portion of the breast. Therefore, the ability to feel and see the implant below your breast skin in this location always exists.

Hi, thanks for your question. In general, for a woman with a small amount of her own breast tissue, placing the implant "under the muscle" (behind the pectoralis major muscle) will look and feel more natural as the muscle provides an extra layer of tissue between the implant and the outside world. It is true that this position does make capsular contracture less likely, and provides a clearer view on mammography as well.

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture).  Also, breast cancer screening with mammography gives better images of breast tissue when implants are placed under the muscle. Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Hello,Thank you for your question. The answer to this is really patient specific. In a primary augmentation for someone with firm skin and small breasts, sub pectoral placement makes the most sense for many reasons, including less palpability and a more natural look. The animation deformity which can present itself is a drawback to this position. In very thin patients with thin breast skin, rippling may be seen or felt in the lower breast pole regardless of placement because this portion of the implant will not be covered by muscle either way. For my patients who have adequate fat and breast tissue and a slightly deflated or drooping breast appearance, I may recommend sub glandular placement instead to provide a perkier look. This advice is based on an in-person exam and detailed discussion of the patient's aesthetic goals.I recommend that you let your plastic surgeon know what you want to achieve and what your concerns are when choosing implant placement.All the best 

I agree with the plastic surgeon you saw in LA.  Under the muscle is better in my opinion for all the reasons listed in your post.  I also feel the implant looks more natural.  Yes the lower pole of the breast may have some palpability of the implant because in that area the muscle does not cover the implant but this is better than the whole implant being palpable

I think the shape of the person's breasts, their weight, and their lifestyle has a lot to do with where to place the breast implant.  Most of the time, I place the implant under the pectoralis muscle.  This is one additional layer of tissue that helps with creating a natural appearing shape.  This is especially true for very thin patients and patients who do not have a significant inframammary fold.  For patient's who have a borderline droopy breast with a bit higher body mass index, placing the implant over the muscle can look beautiful especially with using a silicone filled implant.   In these patients, the risk of a double bubble phenomenon would be lower by placing the implant over the muscle without the need to perform a breast lift.  For an avid workout fiend, using an anatomically shaped implant over the muscle may allow the patient to work out as she desires without the muscle impacting the shape of her breasts.  I would recommend you get a few different opinions on this relatively controversial topic by seeing a few board certified plastic and reconstructive surgeons.  Things are always changing in our field and individualizing treatments seems to be the best way to approach the care of patients.  

The most natural look and feel of breast enhancements is achieved with silicone implants under the muscle.  The chance of "rippling" is also less performed in this manner. For more info and before and after pictures please feel free to contact us any time. Warm regards, Lane Smith MD8871 W Sahara Ave. Las Vegas, NV 89117(702) 838-2455

Your plastic surgeon is right. However, even implants that are "under the muscle" are not under the muscle in the lower outer portion of the breast because the pectoralis major is a fan-shaped muscle that covers about 3/4 of the implant. So any woman with a breast implant can usually feel the implant underneath and on the side. But that is normal and nothing to worry about. It is common to feel ripples in the surface of the implant. It is less common to see them but that can happen in very thin women. If you wish to read more, I have attached a link to my website.