Slightly Droopy Breasts - Implants over or Under the Muscle?

One surgeon recommended OVER the muscle 270 cc silicone implants to improve the appearance of my moderately droopy breasts. He felt going UNDER the muscle would be risky since the implants could sit higher on my chest than my actual breast tissue. I do a lot of weight lifting, so that might have figured into his decision that going over the muscle was the better choice. I’m 5'3", 128 lbs., muscular. What are your thoughts? Thanks in advance!


UPDATE: added my own photos after the before/after

Doctor Answers 21

Over or Under the Muscle

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Implants being placed over the muscle to "lift" the breast is not an effective way to treat sagging breasts. If you need to have your breasts lifted, then you need to have a lift. Lift come in variable shapes and sizes, but all come with a scar. The issue is not just adding a bigger implant which will eventually lead to more significant droop.  The key is getting the best operation. and not setting yourself up for failure with a second procedure, more costs and more time out of your schedule.

Consult with several surgeons to get the MOST accurate information, and trust your judgement on whether their information sounds accurate and beleivebale. Going under the muscle may lead to an animation deformity - the implant can move with the pec muscle, but this is usually less of an issue with visible implant edges or rippling.

Best of luck!

San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Listen to your surgeon

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Professional, competitive body builders and fitness models are usually better off with implants placed above the chest muscle. I suggest listening to your surgeon, or seeking a second opinion based on a physical examination and discussion of your goals.

Advice for breast augmentation

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Hello, The first step is to decide what breast size you want to achieve with breast augmentation. Regardless of volume if you choose saline it would be better to undergo under the muscle, and if you choose over the muscle you should go with silicone. In the ideal world any breast ptosis would be addressed with some type of breast lift as a breast augmentation is primarily designed to improve volume. If the amount of ptosis is very mild then a silicone implant of a certain size and diameter on top of the muscle may help. Based on your photos you may be able to go with a small implant on top of the muscle +/- a purse string mastopexy if needed. All the best, Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Implant position

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The choice is yours but there is +'s and -'s for each location.. There may be flexion deformities under the muscle however, if you do not have a lot of soft tissue coverage, it gives more coverage int he superior pole. Under the gland may limit the coverage.  As for strength, there probably is no effect on weight lifting ability once you have healed.

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

Submuscular implants are usually better than subglandular.

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Subglandular implants have several potential disadvantages compared to submuscular:

  • possible higher capsular contracture rate over the muscle;
  • more risk of visible rippling;
  • more visible implant borders;
  • lower implant position/less upper pole fullness;
  • perhaps less longevity of the result due to less soft tissue support.

Some surgeons do prefer to place the implant over the muscle when there is mild to moderate droop, but for the above reasons, I think the disadvantages outweigh the benefits.

In some cases a breast lift (mastopexy) is needed to elevate the breast tissue and center it over the implant. In some cases a dual-plane augmentation, in which the pectoralis muscle is released from the breast tissue, to allow the implant to settle a little lower, may also be a viable option in some cases. The optimal choice depends on the degree of droop, anticipated size of the implants, skin and breast tissue quality, etc.

Thanks for your question.

Steven Goldman, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 168 reviews

Breast Augmentation and Droopy Breasts

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When deciding on the position of the implant either under or over the muscle it is very important to consider how much 'sag' your breasts have and whether or not you are going to do a lift.  I usually place my implants under the muscle, however, in a patient who has mild breast 'sag' but does NOT want a breast lift as well, I place the implant over the muscle as your surgeon has recommended for you.   This helps to prevent a 'Snoopy Dog' defromity in which the breast itself droops over the implants which are positioned higher on the chest when placed in the subpectoral position.  A board-certified plastic surgeon will guide you appropriately and, based on what you describe, it appears you are heading in the right direction.  Best of luck!

Louis DeLuca, MD
Palm Beach Plastic Surgeon
4.9 out of 5 stars 58 reviews

Over the muscle vs under the muscle implants

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Dear Judybee,

I generally never recommend placing implants over the muscle for any reason. Implant placement over the muscle has more cons than pros in my opinion. Sub muscular placement is superior for many reasons: Less contractures, more than just skin envelope to hold implant in place, etc. If you are in need of a lift and would like larger breasts, then I would recommend a breast augmentation with a donut mastopexy (scar around the areola). If you just want a lift and  no implant, then I would suggest an Ultimate Breast Lift. This technique to lift your breast mound without any visible scars. It reconstructs your existing breast mound to form an inner cone to give you projection and cleavage. Hope this information helps you. FYI, implants will always stretch tissue with time; requiring you to need lifts periodically. Hope this info. helps.

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Droopy breasts and implants

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It is important to understand that implants alone can not achieve a significant lifting of the breast. Your surgeon should guide you to perform the right operation for your breast.

I understand the photos in this question are not yours. The result is an acceptable one for some individuals who are willing to sacrifice breast aesthetics to avoid scarring. The areola remains quite large and the nipple position is too low. This has nothing to do with implant position above or below the muscle.

There are advantages and disadvantages to both positions. There are also ideal breast types for the subglandular and subpectoral position.

Seek out a board certified plastic surgeon to explain these issues to you so you can make the correct decision for you.

Good luck and I hope this was helpful.

Robert W. Kessler, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 130 reviews

Over the muscle will probably give you a more natural appearance

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Since you do have some drooping of your breasts, if you do not wish to have a breast lift done, then I would recommend breast implants on top of the muscle for a more natural look.  For the best results, I would recommend a vertical ellipse mastopexy and submuscular implants.

James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Droopy breast, over or under the muscle

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There are advantages to submuscular augmentation, however the implant must fit within the skin envelop of the breast, hand in glove, to look and feel 'right'. If you wish only a small increase in volume, say 270cc, and the skin envelop is fuller, the implant may sit better and blend and flow better in a subglandular pocket. The implant under the muscle, if not large enough to 'flesh out' the breast may allow the breast itself to move over the implant in a kind of disconnect. Your doctor is probably right.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.