Should I have an over the muscle or under the muscle teardrop shaped gel like implant?

2 doctors recommended under muscle implants and one was adamant about only over the muscle for my body Type. Originally wanted lift because I don't want huge breasts. Would like them to look how they do when I wear extra padded bra and look fuller when naked or in swimsuit. Considering textured teardrop shape , gel and want a natural but not droopy look. 1 Dr. says wider and other elongated teardrop. I like idea of over muscle but seems most go under. Which should I do?

Doctor Answers 5

Should I have an over the muscle or under the muscle teardrop shaped gel like implant?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

For decades I placed almost all breast implants above the muscle. It seemed to have the advantage of simplicity and a faster recovery time. However, I now place virtually all implants behind the muscle (biplanar). 

Behind the muscle offers a lower encapsulation rate, and this is the problem that plastic surgeons and patients have been fighting since the beginning of breast implants. The risk of wrinkling of the implants is also lower when placed behind the muscle.

Regarding recovery time, there is no difference now that specific exercises are done starting on the first postoperative day. After having performed several thousand implants with both techniques, I am comfortable suggesting that with few exceptions, the implants should be placed behind the muscle for the best long-term result.

Thank you for your question, and best wishes to you for your upcoming surgery.

Breast Lift Intended Result - And Determine the Proper Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is used for #breasts which sag or droop (ptosis). Sagging of the breasts may occur with normal development for some women, or as part of the aging process. Pregnancy, breast-feeding and weight loss are other conditions which increase breast ptosis. Some patients will have a better shape to their breast such as increased superior fullness if an #implant is used at the time of mastopexy. This is called an #Augmentation/Mastopexy. The procedure can also be combined with a minor breast reduction to reduce the breast width if desired. The surgery will create an elevated, more youthful breast contour. Also, the procedure will create nipple and areolae of the desired size and at the correct height. 

#FatGrafting is another option to using #breastimplants and requires a small amount of liposuction to obtain the fat which is the prepared and transferred to the breast. 

A hybrid operation may use both an implant and fat to provide the best contours of the lifted breast.

I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.


Implants and No Lift: This is usually a mistake. Most breasts will look larger and droopier.  They will sag more and sooner because of the excess weight.  The shape will usually not be satisfactory. There will sometimes be a “Snoopy” breast or double bubble.

If the nipples are in a fairly high position on the breast or “glandular” ptosis or drooping, an implant may be useful.

The final decision will be yours, but the best thing to do is to discuss all of your questions and concerns during consultation with a board certified plastic surgeon to help determine the match of your procedure to your desired results.

Implants above or below muscle?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The best place to put an implant depends on many factors, but the most significant is amount of tissue on top of the implant (how much breast tissue or fat do you have over your chest), how droopy are your breasts, and what type of procedure you are planning to have.  If you are going to have a lift, or have thin overlying tissue, you are better off with an implant below the muscle to improve the vascularity of the overlying tissue, and you can camouflage the implant more.

Answering questions like this are difficult without an in person evaluation. Please seek a plastic surgeon certified by The American Board of Plastic Surgery when seeking an opinion.

Breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello and thank you for your question. There are several advantages and disadvantages to over vs under the muscle.  Under the muscle has the advantage of lower capsular contracture rates, less risk of rippling, and better visualization with future mammograms.  Most patients say that under the muscle also has a more natural look and feel.  The size, shape, and profile 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.

Best wishes and good luck.

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

Implants -over or under the muscle?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for asking about your breast implants.

  • If you are having a breast lift, it is best to have implants under the muscle to protect against poor healing and infection.
  • If you are very thin, implants usually look better under the muscle.
  • Otherwise, over or under the muscle are both acceptable - 
  • Over the muscle looks more natural and heals faster.
  • Capsular contracture is more common in over-the-muscle implants.
  • A small tear-drop implant over the muscle in a woman who is not skinny should be fine.
  • Most surgeons today only do under the muscle because they were never trained to do it over the muscle.
  • Older surgeons usually are comfortable doing it both ways and know the pros and cons.
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

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.