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

I am having doubts between submuscular and subfascial placement. I am a thin woman, which for most PS is a sign to go with submuscular or dual plane augmentation. I want them to look good but I am afraid of distortion of the breast with muscle contraction, rippling and implant edges being very visible. Can a small implant 200cc - 250cc placed in the subfascial plane look natural in a thin woman? Or is it better to consider a 280cc placed submuscular? I am 5.1ft, 88lbs and BWD of 11cm. Thanks

Doctor Answers 15

A Small Implant Placed Above the Muscle Look Natural in a Thin Woman

Yes it can. I would put silicone implants over the muscle. Looks like you have mild asymmetry and might use two different sizes. Implants cant go under the fascia -- that is not a real operation, they either are over the muscle or partially (dual plane) under. Most of my implants now are through the nipple to minimize the scar and silicone over the muscle. You should do well.

New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Treatment of asymmetric breasts

Your posted photo shows widely spaced breasts without cleavage, stretched out areolae,right breast crease higher than the left, right nipple higher and further from the midline than the left nipple and right breast smaller than left. Every approach has its pros and cons you will need to weigh those before deciding what to do. Under the muscle implants can distort with muscle movement if the muscle release is inadequate but the risk of visible rippling is less.

In your case it is as or more important to make surgical adjustments to the breast skin and tissue and place a larger implant on the right side. The right breast fold will likely need to be lowered and the nipple complex positions adjusted in order to achieve an optimal result. You do not have cleavage now and it is important to realize that breast implants cannot create that cleavage.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast Implant Above or Below Muscle?

Dear Alice 87, Thank you for your question and photographs.  It would be easier to give you good advise in person than with this limited information.  You have concerns about some of the ways a below the muscle/dual plane positioning can look unnatural.  I would put more emphasis on the ways an above the muscle implant can look unnatural.  You have a petite frame and low body weight.  A dual plane placement would give more tissuecover over the implant and hide implant surface characteristics.  You will be less likely to see implant margins and wrinkling.  Be sure to discuss this with your plastic surgeon.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 114 reviews

Over or under the muscle for breast augmentation

Yes, a small implant 200cc - 250cc placed in the subfascial plane can look natural in a thin woman. A 280 cc implant is only 12% larger than a 250cc implant. If distortion on muscular contraction is a big issue for you, go subglandular/subfascial. Be advised, however, that submusclar can be easier for mammograms and has a lower rate of capsular contracture.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Breast Implant Placement

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"   

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 269 reviews

Go with submuscular augmentation

It is a mistake to have sub glandular augmentation due to the much higher incidence of capsular contracture, rippling and visible implant edges. A properly done biplane technique without excessive muscle release will get you a great result without excess muscle motion.

John Squires, MD
Denver Plastic Surgeon
4.9 out of 5 stars 79 reviews

Breast implant size, type, and position

The standard after many years of experience and improvements in pocket formation and muscle adjustment is to place breast implants below the pectoralis muscle for the central and upper part of the breast for short term and long term results of padding, protecting, and camouflaging the presence of the implant. This helps avoid the rippling and implant edges you are concerned with and with proper dual plane release of the pectoralis muscle you shouldn't have significant distortion with muscle contraction. 

The implant volume in cc's should be determined by the width of your breast and your choice of forward profile, not a preconception about implant size for above or below the pectoralis muscle. One size does not fit all and thinking in dimensions of the implant and their effect is better than thinking in terms of  overall volume. 

In your case, regardless of how thin you are, you appear to have enough tissue tone and coverage to conceal an implant above the pectoralis muscle in the short run (assuming it is gel-filled and not the maximum forward projection). The problem is that you will gradually lose tissue tone and coverage over the implant and eventually it will become more visible. I would recommend a properly sized silicone gel-filled implant positioned in the dual plane sub-pectoral position done through an inframammary crease incision as the best short term and long term result for you. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Submuscular vs Subglandular Implants

  • 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.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 59 reviews

Breast implant position

 I think you answered yoru questions yourself.  FIrst please note your aysmmetry( everyone has it). But with thin patients it is often better to place them in a dual plane position.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Positioning of Breast Implants

Thank you for the question.

I would suggest sub muscular ( dual plane) breast augmentation in your case.

Although breast implants in the sub muscular ( or dual plane)  position may experience “distortion” with muscle movement (workout) I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.