Textured silicone placement above or below the muscle?

I am 5'4 and weight 130lbs. I currently wear a 34D. I had a child and breastfed her for one year. They are not as full as they were before. I cannot decide what option is best for me. Above or below the muscle? I have seen two certified plastic surgeons and one suggested over and the other suggested under. My main goal is to have them more full and perky but not obviously fake. Any recommendations appreciated. Thank you!

Doctor Answers 8

Over or under

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I agree with most of the other surgeons comments. I also usually prefer to go under the muscle, but there are a few indications to go above the muscle including; if there is a moderate amount of breast posts or droop and a breast lift is trying to be avoided, sometimes over the muscle will improve the breast shape. Also, some patients do want as much upper breast fullness as possible and have a rounded/implant look to the upper breast. It all depends on what your goals are and what your breasts look like prior to surgery.
Good luck, 
Ian Lytle, MD 

Dearborn Plastic Surgeon
5.0 out of 5 stars 21 reviews

Impalnt pocket

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In the majority of cases, I prefer to place the implants under the muscle.  I think that it offers more soft tissue coverage.

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

Textured silicone above or below the muscle

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I usually recommend a submuscular placement for breast implant placement. I feel that it "hides" the implant better, the position is better maintained, it is better for reading mammograms and the rate of capsular contracture is less. Smooth implants are more commonly used in the US.There is currently a fair amount of discussion regarding the use of textured implants due to the extremely rare occurrence of ALCL that is associated with some texturing. (At a national plastic surgery conference held in April 2016, the use of textured implants was discouraged.) If you are still preferring placement above the muscle, past research has shown that textured implants have a lower rate of capsular contracture than smooth. Best wishes for your decision!

Ellen A. Janetzke, MD
Bloomfield Hills Plastic Surgeon
4.7 out of 5 stars 20 reviews

Textured silicone placement above or below the muscle?

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Thank you for sharing your question.  I tend to recommend that patients have their implants placed beneath their pectoralis muscle as this plane trends towards fewer complications and has the advantage of reducing implant sagging and rippling, and in women with little breast tissue, this plane lends a more natural appearance.  Hope this helps.

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

Smooth under

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I recommend smooth implants under the muscle whenever possible to decrease rippling and scar tissue formation.

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 43 reviews

Textured silicone placement above or below the muscle?

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Below the muscle is preferable if possible, this will provide more coverage of the implant. For what it is worth at a recent international meeting a survey of experienced board certified plastic surgeons 83% of surgeons surveyed use smooth round silicone breast implants.

Textured silicone placement above or below the muscle?

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There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular).
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) they can be seen with breast implants placed in the sub muscular position.
I hope this, and the attached link, helps. Best wishes.

After over 5000 breast implants procedures, in my opinion....

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the below the muscle is the way to go.  It does not effect recovery, discomfort, and virtually lowers most of any risks related to the implant.  In my practice, even bodybuilders will opt for below the muscle even though they use there pectoralis muscle.  My recommendation is to seek out an experienced board certified plastic surgeon that specializes in cosmetic breast surgery similar to our practice.

Peter J. Capizzi, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 93 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.