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 3

Implants above or below muscle?

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.

Orlando Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast augmentation

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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

Implants -over or under the muscle?

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.