Do I get the implants over or under the muscle? I can't decide which is better. (photos)

I'm about to get a breast lift and implants in 2 days. I have previously discussed with my surgeon that I am going to get 275cc low profile rounds under the muscle. I'm afraid that I will lose size (or is 300 too much?) and they will look too 'tear drop' My current issue is that my breasts are somewhat saggy.

Doctor Answers 7

Do I get the implants over or under the muscle? I can't decide which is better.

There is not much difference between a 275 and 300. I don't think you will lose size with either of the options. Your Plastic Surgeon will have a reason to suggest Under the Muscle option, its best you discuss this with your PS before your surgery. All the best

Sydney Plastic Surgeon
5.0 out of 5 stars 74 reviews

Submuscular approach + Mastopexy

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? This is question is fast becoming my most commonly encountered question here and elsewhere. There is no simple blanket answer to the this question. The response is as varied as the patient posing it. While many surgeons recommend submuscular placement there are distinct differences to each approach. Additionally, for patients undergoing a lift in conjunction with their augmentation, many surgeons (as do I) recommend a sub muscular 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.  I would recommend a submuscular approach. 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 10 reviews

Breast Lift with Implants: Under the muscle is safer

When getting a breast lift, under the muscle would be safer. Circulation is more compromised and increased complications to the nipple can occur when an implants is place over the muscle in combination with a breast lift. The 25cc difference (from 275 to 300) represents less than 2 tablespoons and is equivalent to about one notch on your bra strap. Hope this information is helpful. Good luck to you. For more information on this and similar topics, I recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 78 reviews

Do I get the implants over or under the muscle? I can't decide which is better.

There are many benefits to having breast implants placed underneath the muscle.  In particular when the left is being done, placing the implants under the muscle protects the blood supply of the nipple areola and reduces the risk of capsular contracture and later date.  Implant sizes based on your base width of your breast and once you have recovered I do not believe you lose size with placement under the muscle.  However discuss with your surgeon whether you can add an additional 25 cc based on your base width of your breast. For more information on combination breast lift and augmentation please visit the link below:

Do I get the implants over or under the muscle? I can't decide which is better

the difference between those size implants is minimal. I do not think either one will give you a tear drop shape. Any tear drop appearance will more likely be controlled by the shape of your natural breast tissue after the lift is performed.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Do I get the implants over or under the muscle? I can't decide which is better.

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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Over or Under Breast Implants

You have enough breast tissue to cover the implants well. However, the incidence of capsular contracture is less when placed beneath the muscle. Also, the submuscular placement aids in mammograms which is beneficial for your overall breast health. 

You should see a board certified plastic surgeon in your area to get a formal opinion through an in-person consultation.

Best of luck,

Vincent Marin, MD

San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 47 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.