Is it better to get breast implants on top or under the muscle?

Doctor Answers 13

Implant placement

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Hello and thank you for your question. It really depends on your individual anatomy and goals.  Implants placed under the muscle have less risk of capsular contracture and rippling and tend to look and feel more natural.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Implant pocket

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In the majority of patients I prefer to place implants under the muscle because I think it provides more soft tissue coverage especially in the upper pole.

Breast augmentation

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Thank you for your question.

It differs per patient, although I generally do recommend under the muscle. I would recommend that you schedule a consultation with a board certified plastic surgeon so they can perform a physical examination and take measurements so they can recommend the best implant type/sizes for your body. There are 3D simulators that can show you what you would look like with different types of implants and different sizes, this can be helpful when trying to decide what size would achieve your cosmetic goals. At my office, I use high profile Sientra implants to create a round full result that looks natural, giving you the result that you want. Additionally, i use Crisalix which is a virtual reality device that will allow you to view different sizes of implants and pick which best suits your desires.  As the only board certified plastic surgeon in Pittsburgh offering this virtual reality imaging system, we have a 100% satisfaction rate.  Crisalix is truly a unique experience for our patients as they can view themselves using virtual reality goggles and can instantly visualize their own breasts changing in size and shape with all of the various brands, sizes and shapes of breast implants.  Thus, our patients leave the consultation feeling confident with the size of the implant they chose. 
Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

Breast Implants Above or Below the Muscle? #breastaugmentation #dualplane

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  • I typically place breast implants in the "dual plane" position.  This means that most of the implant is covered by the muscle, while the lower-most portion of the implant is covered by breast tissue.
  • I have found that this tends to give the breast the most natural appearance.
  • Also, I think there is less of a chance for visible rippling in this position.
  • Lastly, there may be a lower chance of capsular contracture in this "dual plane" position under the muscle as well. 
  • One last thing I would mention is that if a patient picks a very large implant, it will not look very natural in either position, under or over the muscle. 

Is it better to get breast implants on top or under the muscle?

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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)  they can be seen with breast implants placed in these sub muscular position.    Best wishes with your upcoming surgery.

Breast augmentation's implants' placement

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I have performed many breast augmentations in my carrier.

In the 90% of them the implant was placed under the muscle and 10% of the cases had an above muscle placement.

Nearly all patients, which I placed the implant over the muscle, had to be operated again some years after. Revisions were needed very rarely to the below muscle placement patients.

Implant position conundrum

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Thank you for your question as this is a very common one.  The factors that determine the optimal pocket plane for an implant include your skin and tissue quality/thickness, presence of stretch marks, any prior procedures, amount of ptosis (if any), appearance/size goals (which may not align with your tissue limitations), surgeon comfort and experience with a variety of tissue planes, and  type of implant.  Placing an implant in the sub-glandular plane is often times more natural when the overlying tissue can support it because that is the natural position of the breast.

A thorough examination, including dimensional analysis and 3D imaging, will help you and your surgeon determine the ideal implant style and tissue plane that will achieve your goals while limiting complications or secondary effects.  Consulting with a board certified plastic surgeon is critical.

Breast implants

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thanks for your question and it's simple but a loaded one! There are many reasons to do either position . However for the most part, under the muscle is used the most (actually what's called dual plane). It's a discussion that a breast specific plastic surgeon will have with you. Best wishes!

Breasts augmentation under the muscle

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Dear jnut,

     I have been in practice for over 29 years and performed breasts augmentation with implants on thousands of patients , many of them are mothers and daughters, sisters or family members and friends, which attest to the fact that they are happy with the outcome of their surgery. I place the implants exclusively  under the muscle for the following reasons:

   1. Statistically there is less capsule contracture in comparison to sub glandular technique.

   2. Better coverage of the implants, which makes them feel more natural.

   3. The sensation nerves to the nipple go on top of the muscle, so when dissecting the pocket under the breasts tissue, it is more likely to damage the nerve and lose sensation. In some studies there is 30% nipple sensation loss when implants are placed under the breasts tissue. Under the muscles, the sensation loss is 3-5 %.

    Not all results are the same, because experience, skills and aesthetic eye are critical for good outcome. So do your due diligence carefully and choose your surgeon wisely to avoid bad outcome and redo surgery.

    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking. Also, check the reviews on 'RealSelf' for ratings and positive experience reports.

                     Best of luck,

                                              Dr Widder

Breast implants vs muscle

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It depends upon your particular situation. Generally, under the muscle is preferred, especially in thin patients. Over the muscle can give a more natural look with easier recovery but may have a higher chance for rippling, capsule, etc. Gels such as higher filled Sientra or Natrelle Inspira are a good choice for above.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

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.