Can a Small Implant Placed Above the Muscle Look Natural in a Thin Woman? (photo)

I favor putting implants under the chest muscle because my radiology colleagues  think  this  position  interferes  less  with  mammography  and  the early  detection  of  breast  cancer  than  if  the  implant  is  placed  on  top  of the  muscle.  Not  all  surgeons  agree  on  this,  but  I  like to  err  on  the  side of  caution. The  alternative  is  to  place  the  implant  on  top  of  the  muscle but under the breast tissue. The chance of irregularities is much higher when the implant is placed on top of the muscle in a patient who has little overlying breast tissue to cover the edges of a saline implant (incidentally, this isn’t as big a problem with silicone.  All the best.!  "Dr. Joe"   

The over the muscle, under the muscle question has no simple answer.  Either position will result in a natural appearance if the procedure is performed well and an appropriate sized breast implant is selected. These two aspects of the procedure are most important.  Different plastic surgeons feel strongly one way or the other, sometimes for no reason other than they do it more often one way or the other. One option may work better for a certain type of patient and this is related to breast volume, breast shape, droopiness if present and the amount of body fat.


 


The simple reason to have the implants under the muscle is to add an extra layer of coverage over the implant to avoid wrinkling or edge visibility.  The down side is the possibility of implant movement with muscle contraction.  Having said that, in my experience, wrinkling and implant visibility is much more common than implant movement, which the patient finds to be a problem.  I have not actually had a patient complain of implant movement after a breast augmentation and most of the breast augmentations I perform are submuscular. In a body builder the movement may be a problem, but in the average patient this is usually not an issue.


 


By your photos you actually seem to have a moderate amount of breast tissue and it will be up to you and your plastic surgeon to decide which way you will like to go given the advantages and disadvantages of each procedure.  I think you are wise to be considering conservative sized implants, as these tend to look more natural in most patients.  In my opinion, the subfascial plane is essentially going to have the same appearance as subglandular since that layer is essentially paper thin and does not add any additional coverage compared to the extra coverage that the muscle affords.


 


In most cases when the breast implant is submuscular it is only partially covered by the muscle and the term dual-plane refers to the fact that the superior part of the implant is covered by muscle and the lower part of the implant is not.  The plastic surgeon can vary the position during the breast augmentation procedure in order to adjust the appearance of the breast.  This can particularly helpful in the breast with some droopiness.