Breast Augmentation. Would above the muscle be an option for me?

I am considering a breast augmentation. I would like to consider above the muscle with silicone gel implants. One of my friends had above the muscle and they are one of the most natural I have seen. Would this be an option for me as I am 5 foot 8 and 58 kilos with small breasts, athletic and like to run and weight train. I am 47 with no children. I only want small maybe 250 - 300cc. Please advise thoughts and any recommendations on a surgeon would be much appreciated.

Doctor Answers 17

Above the muscle or beneath the muscle placement of implants have distinct benefits and risks.

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Of course, without examining you, I can not give you definitive recommendations for the position of placement of your implants. In truly athletic patients with large pectoralis major muscles and reasonable size expectations, I usually suggest the use of textured gel implants in front of the muscle. 

Subglandular positioning of small implants with adequate breast tissue coverage can provide aesthetically pleasing results with less post-surgical pain and a quicker recover for lean athletic patients.   The risk of visible breast surface distortion with pec. major contraction is avoided as is the risk of a double bubble deformity.

The placement of your implants should be discussed with your experienced cosmetic plastic surgeon(s) in consultation...

Best Regards,

Colorado Springs Plastic Surgeon
4.9 out of 5 stars 69 reviews

Breast augmentation over the muscle for athletic women

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From what I can tell, you are likely a good candidate for over the muscle silicone breast augmentation.  If you go under the muscle, your breasts will look like 2 puppies fighting under your shirt when you work out your chest.  To me, that doesn't look very natural despite what other doctors below have said.  You can choose from round or "anatomic" shaped implants depending on how soft you like the upper part of the breasts.  Also, if you go under the muscle and exercise you pectoral muscles, over time, the muscles will stretch out the internal breast implant pocket and cause the implants to drift laterally and downward.  If you would like more information, feel free to contact me.  Best wishes!

Above the muscle??

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You are a great candidate for behind the muscle. It is ideal to have a much natural tissue in front of the implant in small breasted women to reduce palpability/rippling. Choosing the proper dimensions of implant will allow control of how much upper pole fullness you gain.

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Breast Augmentation Above the Muscle...?

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Breast Augmentation above the muscle has largely fallen out of favor by plastic surgeons.   There are many reasons why implants placed under the muscle is better.  
1. Implants above the muscle add more weight to your breast which is supported only by your skin and will add to the tendency to droop. 
2. Capsular Contracture (Breast Implant hardening) rates are much higher above the muscle than under the muscle.
3.  Most importantly, Cancer detection on mammograms is better with the implant under the muscle.  
4. There are many other reasons why under the muscle is better.... less palpability of the implant, less visibility of folds and ripples, better superior pole fullness, lower risk of synmastia (uniBoob) 

You can never choose your surgery by someone else's results.  All breasts are different!


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Hello and thanks for the question. Comparisons with your friend are not reliable. She may have a great result because she had more native breast tissue to start with and small implants were placed. Please see a BCPS for breast and chest measurements. 

Good luck



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It is possible to go above the muscle. My preference is to go below the muscle to give more soft tissue coverage over the upper pole.

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

Breasts implants pocket location and implants size selection

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  • Dear Tb,

  Thanks for submitting your pictures.
 From observing your pictures , you appear to have nice and perky breasts with wide cleavage and your size looks like small A cup.
 I have been in practice for 29 years and performed breasts augmentation with implants on many athletes. The most common size selected by these patients was full B cup size or small C cup size, which makes sense due to their intense sport activity.
  In regard to implants size selection, you did not provide your chest circumference in inches, which is critical for the correct implants size selection. Let's assume that you are currently  34 small A cup size. To become 34 small C cup size, you will need implants with volume of 300 cc.
 I place the implants through a sub areola incision as oppose to sub mammary fold , because the scar is friendlier  and this entry allows for pocket dissection under direct vision and feel, which creates beautiful cleavage, symmetrical breasts and precise fold.
  As far as pocket location, there is a reason why most surgeons in the US place the implants under the pectoral muscles. 
  Here are the reasons:
 1. Much less loss of nipple sensation, because the nerves are crossing above the muscle, exactly where the pocket is made with the above the muscle technique.
 2. Better coverage of the implants, especially importants in thin peoples like yourself.
 3. Statistically, less capsule contracture.
 4. Less hematomas, because the pocket under the muscle is almost bloodless, unlike the other technique.
  Finally, one bird does not bring the spring and your one friend's nice outcome is insufficient to make a judgement. You have to do a good due diligence and choose wisely.
  Always, consult with experience board certified plastic surgeons who do lots of breasts augmentation surgery in accredited surgery center for your safety. Most importantly, check the before and after picture 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 'Realself' reviews for rating and positive experience reports.
             Best of luck,
                                   Dr Widder

Breast Augmentation. Would above the muscle be an option for me?

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Based on your photos but without an examination, you can achieve an excellent cosmetic result with an augmentation. There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:
Subglandular implant benefits:
  • A shorter recovery time.
  • Less discomfort initially.
  • No distortion of the breast when the pectoralis muscle flexes.
  • Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
  • Easier surgical procedure.
  • Larger implants can be placed.
Subglandular implant disadvantages:
  • The implant may be more visible.
  • More visible rippling, especially in patients with a small amount of natural breast tissue.
  • Generally, saline implants do not produce a good result in front of the muscle.
  • Higher incidence of capsular contraction.
  • “Bottoming out” in some patients.
  • Some radiologists have more problems reading a mammogram with an implant in front of the muscle.
Submuscular implant benefits:
  • Usually results in a better appearance for naturally small breasted women
  • Less tendency for seeing ripples of the implant.
  • A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
  • Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
  • Lower rate of capsular contraction.
  • Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.
Submuscular implant disadvantages:
  • Recovery usually takes a little longer and is more uncomfortable initially.
  • There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
  • It is harder to achieve cleavage in women who have widely spaced breasts.
  • The implants often ride higher on the chest.
Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.

The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach.

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with or if you plan to have the surgery in Australia, the surgeon should ideally be a member of the International Society of Aesthetic Plastic Surgery (ISAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Yes you can

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IF the surgery is done well this is a fine option. You do have and increased risk of capsular contraction and long term results not great if you pick too big an implant which would stretch out your skin. Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Good question.

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Most plastic surgeons recommend an "under the muscle"placement for two primary reasons: 1. The likelihood of capsular contracture (hardening or distortion) is less, and 2. The muscle tends to disguise the round counter of the implant in thin patients making it look more natural and less round a artificial. There is no doubt that above the muscle is a great operation when it works out. You are taking a bit more of a risk with the "above the muscle" option of needing revision surgery if the final result is not what you had hoped for. 

Plastic surgery is not risk free, regardless of the implant you select, the pocket placement, or the plastic surgeon you select to perform your surgery. An experienced board certified plastic surgeon will review all of your options with you. Make sure that you are consulting with a plastic surgeon whose aesthetics align with yours. And make sure that you communicate your visual endpoint with photos, not just with words like "natural", proportionate", "not too big", because all of these descriptions are notoriously subjective and inexact. Also, if you are not confident after your first consultation, don;t hesitate to schedule a second or even third. It is much easier and less expensive to do your due diligence ahead of time than to be disappointed with your outcome and undergo revision surgery.  Best of luck to you. 

Ram Kalus, MD
Mount Pleasant Plastic Surgeon
4.8 out of 5 stars 24 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.