Under the muscle or over?

I do fitness and lift heavt weights and i have a very tiny frame. I'm a 32a. I had a consultation with a surgeon abd he strongly recommended over the muscle and said he thinks it looks more natural. And because i lift heavy, if i had under the muscle the muscle could put to much pressure on the silicone :/

Doctor Answers 13

Actual breast coverage

I perform breast augmentation in a lot of heavy lifter and fit woman, and the decision will always be depending on what coverage you actually have. If you have enough breast tissue to have them placed over the muscle, then I would use a subfacial plane, if you dont, there will be no discussion, under the muscle or dual plane should be, 
Best of luck, 

Dominican Republic Plastic Surgeon
5.0 out of 5 stars 20 reviews

Under or Over the Muscle

In general, the benefits of submuscular breast implant placement are:
  1. Better superior (upper) coverage/hiding the implant in your cleavage where you will show them off the most
  2. Much lower rates of capsular contracture or scar tissue build up around the implant
  3. Most importantly, breast implants under the muscle do not interfere with your mammogram
Dr. Feldman does not believe there to be any lasting benefit of subglandular (or sub fascial) placement. If your breasts are entirely below the muscle he will recommend a mastopexy (lift), not subglandular placement, to take advantage of the benefits mentioned above regarding submuscular implants.A submuscular implant looks better, feels softer for longer and doesn’t interfere with mammograms, giving you the best chance at early breast cancer detection and highest cure rate should it develop. However, it’s not always that simple. Many times the bottom edge of the pectoralis major muscle ends higher than your natural breast crease. If the placement of breast implants lies completely under the muscle it “rides high” and delivers a less than ideal aesthetic result, with your natural breast “falling off” the front of the implant. Therefore, to prevent that, I frequently utilizes a dual plane implant placement. This means as much of the upper portion of the submuscular implant is under the muscle, for all the reasons listed above, but a small portion of the implant “peeks” out from under the muscle so the implant is nearly centered under the nipple. There are different degrees of dual plane release (I, II, III) but I, personally do as little a release as possible to achieve an optimal aesthetic result, thereby leaving maximum muscle coverage.

Evan Feldman, MD, FACS
Texas Plastic Surgeon
5.0 out of 5 stars 86 reviews


When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach:   Subglandular Augmentation:   ·      Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster when compared to subpectoral augmentation.   ·      Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).   ·      Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.   ·      Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.   Subpectoral Augmentation:   ·      Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.   ·      Subpectoral implants have a lower rate of capsular contracture.     ·      Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.   ·      The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.   Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.  As always, your board certified plastic surgeon can help guide you in your decision making process.

Donovan Rosas, MD
Kissimmee Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast augmentation under or over muscle?

Hi charlenedille21,Thank you for the question.   Each surgeon have  specific recommendations and techniques that work well in their hands.  In general, a proper assessment is key to advise you about the advantages and disadvantages of the two pockets. For long term results pocket behind muscle is vital and the best aesthetic outcomes are achieved with a dual plane. But in your case being heavy lifter is also something should be focused and more questions needed to be asked for proper assessment. Please discuss all these with you local plastic surgeon. Good luck

Ercan Karacaoglu, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 23 reviews

Over or under, that is the ??

So as with most breast augmentation patients, you are small and do not have a lot of breast tissue. So, concealing the implant under the muscle would be your best plan. As other surgeon have said, because you are a weight lifter, having a total sub muscular implant would be a bad choice for you, you need to find a surgeon who performs dual plane breast augmentations, this will put the implant in the best place in regards to complications such as capsular contracture while also hiding the implant under the muscle so it is less visible.

Nathan Eberle, MD, DDS
Weston Physician
5.0 out of 5 stars 6 reviews

Implant placement - breast augmentation

Thank you for your question.  This is one of the decisions that is discussed at length with every patient seeking breast augmentation.  In general, the advantages of placing the implant above the muscle are that there is a slightly shorter recovery, and you eliminate the chance of having an animation deformity (movement of the implant when flexing your pec muscles).  However, the majority of women elect to have the implants placed below the muscle, typically with a 'dual plane' technique, for several reasons.  The muscle provides another layer of coverage and protection for the implant, helps soften the transition from your chest to the top of the implant, and there is historically a lower risk of capsular contracture when the implant is below the muscle.  There may be slightly more discomfort during your recovery, but this can be greatly reduced with a rapid recovery protocol that incorporates stretching into your early recovery period.  It's always important to consult with a board certified plastic surgeon in order to determine the best approach for you specifically.  Best of luck!

Benjamin Wood, MD, FACS
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 13 reviews

Under or over the muscle

Hi there, That is an interesting question and one that regularly comes up at meetings. Recently in a chapter on breast augmentation in the most recent comprehensive single volume reference textbook we looked at the collective evidence on this topic. The evolution of implants over the past 50 years has seen various techniques to reduce the risk of capsular contracture rates. In the first instance the shell of the implants and the consistency of the silicone gel were changed to textured shells and form stable gels respectively. A postulation that regular movement of a gliding muscle over the implant would reduce the rate and incidence of capsular contracture rates led to this technique innovation with significant clinical evidence in its support. However, a full sub-muscluar implant has some significant aesthetic disadvantages including abnormal animation of implant on muscle contraction which does not improve with time. The more nuanced dual plane seeks to take advantage of the sub-muscular plane whilst doing away with the disadvantages of the total sub-muscular implant placement. The short or it is that for long term results some form of sub-muscular plane is vital and the best aesthetic outcomes are achieved with a dual plane.  Hope this this helps. Good luck.  

Ross Farhadieh, MBBS, MD, FRACS, FRCS
Sydney Plastic Surgeon
5.0 out of 5 stars 11 reviews

General Recommendations for Implant Placement

#Breast implant #cosmeticsurgery is accomplished by surgically inserting either a saline or #silicioneimplant (prostheses) behind each breast. The saline implants are filled with salt water and are placed either in front or behind the pectoralis major muscle and breast tissue. #Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle.  This tends to more common in Europe and South America.  General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option,  #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding. In any case, your plastic surgeon will determine which placement is best for you. When you visit a local surgeon for a consultation, the different options will be explained in further detail.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 107 reviews

Over or under muscle

Hello, different surgeons have specific recommendations and techniques that work well in their hands.  Without a proper assessment it is not possible to advise you about the advantages and disadvantages of the two pockets.

William Andrade, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 62 reviews

Under the muscle or over?

If you place them over the muscle, you will have less animation but you will be able to see and palpate the implants easily because you are so thin. Placing them under the muscle will give you a better result because you will have more padding on top but you may experience animation. Best to talk to a board certified plastic surgeon who can properly examine and measure you and give you the best option for you!

Farah Naz Khan, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 97 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.