Should I get silicone implant above the muscle or under the muscle with no lift? (Photo)

I'm 5 foot and weigh 108 pounds I went to two consults one doctor recommended under the muscle 550 with no left the other doctor recommended over the muscle 346 with a lift but if I did not want to commit to lift right away I could do it later if I don't like my results

Doctor Answers 11

Breast lift with implants vs Implants Alone

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Hello and thank you for your question.

Based on your photos it appears that you would benefit most from a breast lift with an implant.  Given your height and weight, I would not advise placing a 550-599cc implant just for the sake of filling up the excess skin.  Although I do understand your hesitation over the potential scarring, your best outcome would be achieved with a breast augmentation and lift combined. 
I advise that you consult with a board certified plastic surgeon who has a lot of experience with breast surgery.

Best of luck to you!

Atlanta Plastic Surgeon
4.9 out of 5 stars 33 reviews

You need breast lift

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You need breast lift now. Implants can be under the muscle or over the muscle. You will not look good without having a breast lift.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Should I get silicone implant above the muscle or under the muscle with no lift?

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Thank you for your question and photographs. Unfortunately I think you will not obtain a satisfactory result with only implant placement. You have a moderate amount of breast sagging and excess skin to your breasts that will not correct itself with implants alone.  A lift will correct both of these problems while also placing your nipple and areola into an elevated more youthful position and improving your shape and contour. Hope that this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews


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unless you are really paranoid about the scarring, the straight augmentation is not the right operation for you.  you are so petite and your breasts will hang significantly

Jonathan Saunders, MD
Newark Plastic Surgeon

Should i get silicone implants above or under the muscle with no lift?

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Thank you for your question. It looks like you would be best served with a combination of breast lift with augmentation. The parameters of both the breast lift and the position of the breast implants should be designed to keep the implants relatively low while lifting the breast tissue and nipple to sit directly over the implants. I would recommend to place the implants under the muscle.
Many techniques exist in breast surgery, and combined lifting with augmentation is especially tricky. The key is working with an expert, board certified plastic surgeon to get the best plan for you.

Should I get silicone implant above the muscle or under the muscle with no lift?

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From your pictures, you have very little breast tissue, thin skin and a moderate amount of sagging. I don't think you are going to look good without a lift even early after surgery because your tissue is probably going to stretch even more. Large implants will not fill out loose sagging skin, they just make larger breasts that sag which then becomes an even more difficult problem to deal with later especially when the implants are sub glandular. 
I would recommend that you choose an implant volume that fits your chest/breast dimensions and gives you a breast size that matches your goals. I would also recommend subpectoral dual plane placement and a breast lift. This will give you beautiful breasts that have a nice shape. While you will have more incisions than just with an augmentation, your overall shape will be so much better.

Breast lift and implant

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I agree with most of the answers. I would recommend a dual plane submuscular augmentation and a breast lift. The size of the implant should be determined by breast measurements and exam. I have my patients try on sizers to finalize the choice. I would get more in person consults. Good luck.

Appropriate op

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Hi there
from the pics it seems to me that in both the consultations you had you were given the wrong advice
there is significant ptosis and skin excess which nesessitates a lift and from the photos it seems you are quite thin with lack of soft tissue cover for the implant for subglandular placement. Therefore your operation should be a submuscular (dual plane 2-3)augmentation with an uplift. The discussion should be about the size of the implant and wether this should be done in one or two stages although I think one stage should be posdible

good luck

Should I get silicone implant above the muscle or under the muscle with no lift?

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It appears that you have lost a significant amount of weight. In that situation, I would suggest that you place the implants behind the muscle to help keep the implants in the proper position. I would also suggest that you have a lift you achieve a youthful appearance. Good luck!

Over or Under

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Over or under

Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a more narrow cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. With the partial submuscular placement, if the nipple can not be made to line up with the center of the implant, then a lift will accomplish that. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 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.