Are 500cc To Much For Over The Muscle?

I went to 2 diff dr for consults about breast augmentation and im confuse now,,both gave me diff opinion lets see if you can make get the best for me or help im 31 yrs ,height 5' 3" , weight 127 , CUP 34A , BWD 13.0 , MOTHER OF 2 girls and i want to be like D or full D THE first dr said the best for me are silicon with 450 cc over the muscle ,Areola Incision and the second dr said silicon 500cc under the muscle ,Areola Incision.what you think over or under muscle for me and why?

Doctor Answers 13

Breast implants are generally placed subpectoral (under the muscle)

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There are many reasons to have your breast implants placed subpectoral (under the pectoral muscle). It's easier to interpret mammograms, lower incidence of capsular contracture (scar tissue) and a more natural contour to the upper portion of the breast. Those larger sized implants (450 and 500) are quite heavy and may lead your breasts to sag more quickly as you get into your mid-thirties; especially if they are in a subglandular (in front of the muscle) location.

I would also consider an incision placed in the fold of the breast (inframammary) as this is associated with a lower rate of capsular contracture and does not violate the breast tissue as much as the periareolar approach.

For sizing, I prefer to use 3D imaging which simulates what you may look like with various sized implants. This takes alot of the guesswork out of which implant is best for your particular frame.

You may want to visit with one or more board certified plastic surgeons if this is still not 100% clear to you.

Best wishes,


Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

Implant Selection Process

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If possible, I would always recommend under the muscle.  In general, a 500 cc implant under will equal the size of a 450 cc over the muscle.   In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Implant pocket location

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Over or under really depends upon your anatomy. In most cases I prefer under because most of the women I see do not have a lot of soft tissue coverage.  Hard to say without an exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Better results with implants behind the muscle

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Without photos and even more importantly, an examination, size recommendations are pure conjecture. However, for many reasons including the relatively large size of the proposed implants, they should be placed in a submuscular pocket versus above the muscle. These large implants above the muscle will cause rapid stretching and thinning of the skin, will be felt more easily in an abnormal way, and may create creasing/ripples of your skin.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Are 500 cc implants to much for over the muscle?

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With your height and weight, I feel that a 500 cc implant is too large. Although if placed correctly under the muscle, you could still get a nice result. If  the implant is placed above the muscle, I feel that it  will not only be too large but will cause future problems resulting in stretching of the skin and sagging.

Robert Heck, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 83 reviews

Breast Augmentation

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Hello Curiouslatina,

Going under the muscle will give you the best chance of minimizing complications like capsular contracture and rippling in the upper part of the breast.  There is not much of a difference in appearance between a 450 and 500 cc implant, but they are certainly near the appropriate limits of your anatomy, based on your reported BWD of 13 cm.  In an ideal world, 400 cc might be a safer choice, I would need to examine you directly before making a recommendation.  Periareolar incisions are associated with the highest rate of capsular contracture, and I would recommend an endoscopically assisted surgery through an armpit incision by a surgeon that specializes in that approach.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Over or under the muscle augmentation

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I personally perfer under the muscle implants. They look and feel more natural in my opinion. I would suggest you look on line at photos of before and afters of women who start with your volume of breast, and pick out ones you like postop and have a size listed. you should also look for photos both above and under the muscle and pick out the ones you like. there is no wrong answer with under or over, it is personal preference.

Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

How to pick breast implants.

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1)  This is the most common type of question on RealSelf.

2)  It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.

3)  Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.

4)  Then your surgeon has to tell you if your chosen look is realistic for your anatomy.  The most common mistake is to go too big.

5)  I recommend that  the surgeon NOT make a final implant choice in advance, because this is just an educated guess.

6)  The surgeon should have a large inventory of different size and shape implants available in the operating room.

7)  Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.

8)  Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating room inventory, and put in your breasts to complete the operation.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Large Implants Above the Muscle

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Large breast implants above the muscle is a recipe for a second procedure sooner than you would like.  A 450 cc above the muscle and 500 cc below will "show" about the same, but if you are a postpartum A cup, then the implant will be MUCH more visible through the skin in an over-the-muscle position. There shouldn't be a question in a small breasted patient. However, without photos or an exam - all of this is speculation. Just don't try and choose larger implants to take the place of a lift.

Best of luck

Vincent Marin, MD

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Breast Implants Under the Muscle

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Hello ~

The gold standard in the plastic surgery community is to perform breast augmentations under the muscle utilizing a "dual-plane" technique.  There are surgeons, however, who perform breast augmentations above the muscle, and with good results.  Both techniques are acceptable, and there are certainly indications to perform augmentations above the muscle. One such case would be a female body builder.  However there are intrinsic risks with performing subglanduar (above the muscle) breast augmentations.  In our experience, dual-plane breast augmentations offer beautiful breasts with very natural results.

I would recommend following up with both plastic surgeons you consulted with and review with them the risks and benefits of each technique and their rationale as to why they choose one procedure over another. 

Kindest Regards ~

Glenn Vallecillos, M.D., F.A.C.S. 

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 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.