What will my breasts look like when I bend over when they are placed over the muscle?

Question

I have very little sagging (not enough for a lift). My doctor wants to put in round textured implants OVER THE MUSCLE. My concern at the moment is whether my breasts will look like rocks in socks when i bend over because of the placement.

Martin Jugenburg, MD · Answer

Thank you for your question. It is important to have an in person consultation to discuss achievable results and what the best surgical plan is for you specifically. If you are unsure about the plan this surgeon has made for you, perhaps you will consider seeing another surgeon for a second opinion. Best,

Larry S. Nichter, MD, MS, FACS · Answer

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another. See the below link on some suggestions on finding the most qualified Plastic Surgeon for a  Breast Augmentation.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question

After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other peoples bodies and your results will probably be different.

Silicone will give you a fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Paul Wigoda, MD · Answer

I place nearly all of my implants under the muscle. They will look and feel more natural, and have less risk of rippling and capsular contracture. In my hands, there is no downside to under the muscle. The pain level, strength, etc is not any worse. Depending on how much soft tissue you have in your breasts (ie, how large are your breast to start), you may end up looking like two balloons on your chest if you are fairly small chested to start. I would consider either asking to be placed under the muscle or getting a second opinion. Best of luck.

Mark Hanikeri, MBBS, FRACS · Answer

Hi there

It is impossible to answer this question without a face to face consultation and without the benefit of photographs so you should trust the opinion of your plastic surgeon.  If you have sufficient tissue then you can get very nice, natural looking results with implants in front of the muscle although with high profile or large implants, they may not look as natural as natural as teardrop shaped implants in this position.

I would normally use tear dropped shaped, high profile implants in a pre-pectoral position for mild sagging provided there is at least 3-4cm of tissue to cover the implant.

I hope that helps

Kind regards

Dr Mark Hanikeri MBBS, FRACS

Perth Specialist Plastic Surgeon

Tom J. Pousti, MD · Answer

Thank you for the question. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle) that can be seen with breast implants placed in these sub muscular position.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Gary L. Ross, MBChB, FRCS · Answer

When you bend over many patients feel that the implants above feel more like your breast. When placed under, on bending, patients describe the implants feeling fixed and not behaving in the same way. Saying that round implants above have a higher chance of rippling and capsular contracture in my opinion.

Brooke R. Seckel, MD, FACS (retired) · Answer

Over time breast implants placed under the breast on top of the muscle are more likely to sag and the outline of the implant to show.  In addition there is increased risk of capsular contracture when the implant is placed under the breast.  If at all possible I recommend placing implants underneath the chest muscle.

What will my breasts look like when I bend over when they are placed over the muscle?

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