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
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.
Implant position conundrum
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.
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
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,
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 vs muscle
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.
Over or Under the muscle?
Thank you for
The decision to go with over or under the muscle truly depends on your surgeon’s assessment, your goals, etc.
Without an in-person exam, no one can say which pocket would be best for a particular patient.
Open communication with your surgeon is important. Remember, you should never make decisions without understanding their
That being said, I can provide you with advantages and
disadvantages of the over the muscle and under the muscle implant placement.
Firstly, the decision to go behind the
muscle or over the muscle has to do with the amount of soft tissue coverage –
“padding” under the skin. Choosing a pocket that is tight with sufficient soft
tissue coverage not only prevents implant visibility, palpability, and risks of
excessive stretching on the breast, but also excessive implant movement into
the outer or inner sides of the breasts. A hand-in-glove fit for the implant
allows for a natural and long-lasting result. Your surgeon will do a pinch test
in the upper pole of the breast to see how much “padding” you have. If you have
less than 2 cm, then you do not have much padding and it would be best to go
under the muscle. Generally speaking, if your ribs are visible under the
muscle, then you do not have much “padding.” If however, you have more than 2
cm of tissue, then you have the option to go over the muscle or under the
Which pocket do you prefer?
OVER THE MUSCLE
If you are hoping to fully preserve the
functionality of the pectoralis major muscle due to athletics or body building,
or if you have a shapeless, constricted, tuberous, sagging breasts without
cleavage, then over the muscle may be a better option.
- Over the muscle
implant placement causes less trauma to the chest muscles, and the implants
will not be subjected to any pressure or injury due to muscle movement.
- The implant can
directly apply pressure on breast tissue to shape the breasts.
- However, over the
muscle implant placement may have higher risks of breast tissue wasting,
interference with mammography, and capsular contracture compared to under the
- Higher risk of
implant visibility and palpability is possible if you are thin, and this can be
fixed used fat grafting where areas with less tissue coverage are filled with
your own fat to provide better contour and coverage.
UNDER THE MUSCLE
Under the muscle (partially submuscular)
is a preferred option for many surgeons because the muscle helps to maintain a
slope for the upper pole while allowing for a curvature in the lower pole,
while over the muscle will mostly make your breasts appear round and augmented.
- In thin patients,
additional coverage by the muscle reduces the risk of implant visibility in the
upper and inner sides of the breasts. It also reduces risk of synmastia, and
provides less interference with mammography and breast imaging. It also brings
lower rates of capsular contracture.
- However, under the
muscle implant placement may allow the chest muscles to put pressure on the
implant distorting the breast shape and position in the long-term. You may
experience more pain following surgery due to the dissection of some muscle
attachments and you may lose strength while flexing your chest muscle and is
not suitable for athletes and body builders.
So which pocket allows a more natural
There is a difference in opinion, but under the
muscle (partially submuscular) is the best option because the muscle helps to
maintain a slope for the upper pole while allowing for a curvature in the lower
pole, while over the muscle will just make your breasts appear round and
is important that you communicate your goals very clearly, but understand that
you need to have realistic expectations.
this helps, and best of luck!
Breast Implants Above or Below the Muscle? #breastaugmentation #dualplane
- 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?
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.