How should you determine whether to go over or under the muscle?

I'm 5'7 slender with a small B. I want to go to a C cup. My doctor says I should go over the muscle but from everything I've looked up i feel like I should be going under? Not sure which one would be better.

Doctor Answers 21

Under the Muscle Usually Best

Thank you for the excellent question. There are, as others have stated, benefits associated with each implant placement option. In my experience, placing the implants under the muscle usually gets the most satisfying results. I think that would be especially true for a slender patient. The muscle covers the upper edge of the implant and creates a natural slope from the chest to the upper breast. Most of the patients I treat desire natural-looking results. On a side note, submuscular placement also reduces the risk of capsular contracture. Ultimately, you should be comfortable with your decision. Good luck!

Stockton Plastic Surgeon
4.9 out of 5 stars 16 reviews

Over or Under the muscle

Thank you for your inquiry.  Most Plastic Surgeons prefer to place implants under the muscle as there are several distinct advantages to this.  Especially in the thin individual we need to have as much native tissue over the implant as possible to achieve the desired results.  I would encourage you to discuss this with your Plastic Surgeon and maybe even secure another consultation.
Best wishes,

John J Obi, MD

John J. Obi, MD
Jacksonville Plastic Surgeon
5.0 out of 5 stars 4 reviews

Over or under the muscle?

Different surgeons have different feelings with regard to this. The majority of surgeons seem to favor under the muscle for a number of factors. When placed under the muscle, there is less chance of being able to see or feel the implant, especially in a slender individual. There is a lower risk of sagging in the future, easier to get mammograms, and a lower complication rate.

George Volpe, MD
Newton Plastic Surgeon
4.8 out of 5 stars 26 reviews


I believe that the predictability of result and low complication rate favors under in the majority of patients, especially thin and/or small breasted patients and especially with saline.                                   


Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.5 out of 5 stars 79 reviews

Breast augmentation

It is a good question, typically it depends upon the amount of tissue and the size of implants which is chosen. Under the muscle tends to give more padding and a softer more natural upper pole shape. There is also a decrease risk of capsule contracture if you go under the muscle. These are all things that will be reviewed with you at your consultation. Talk to your surgeon about your desires and they can help you determine the best position.

Good luck!

Mark T. Boschert, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 30 reviews

Subpectoral or sub glandular breast implant placement.

My strong preference is toward the placement of all breast implants in a partial subpectoral position. This means that roughly the upper half of the implant is covered by the muscle which provides generally a more natural appearing upper breast slope. There are also some benefits in terms of mammography. The only times I consider placement above the muscle immediately behind the breast gland is when dealing with a dancer or someone who has had previous placement of her implants in that position and they healed well. In my opinion it gives a more "in-your-face" appearance which few patient's desire. I also recommend placement of implants behind the breast gland and above the muscle in patients who are bodybuilders or do serious weight lifting.  For the majority of my patients who seek a more natural look, I feel the subpectoral position is far superior and probably has a somewhat lower risk of capsule contracture.

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Breast Augmentation

Hi, thank you for the question.
well the most important principal its keep the implant with enough tissue
to cover, in patient that have a small breast (A Cup) the evaluation should be 
detail oriented and the option of going under the muscle should be consider 
in patients with more tissue, the over the muscle approach its most of the time the 
right option and less traumatic.

Enriquillo Clime Rivera, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 8 reviews

Over or under the muscle

A lot depends on how big you want to be and how much soft tissue you have.Generally I'll go over if there is a lot of soft tissue and especially if the breast is somewhat sagging.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

Breast Implant Placement

As you can see from the range of answers, every surgeon has a different approach. And without seeing you in person, it is impossible to give you an accurate recommendation. I would advise you to schedule a consultation with another board certified plastic surgeon in your area for a second opinion. See if they line up. Then you can make a more informed decision. Best, Dr. Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Over or under muscle for breast augmentation

I rarely if ever recommend going over the muscle.  Under the muscle has many advantages including better appearance and less chance for capsular contracture.  

Mark A. Schusterman, MD
Houston Plastic Surgeon
4.9 out of 5 stars 77 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.