Under VS over the muscle. What's the difference? Undecided if I should 600cc or 650cc?

I appreciate your question.





The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  





Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.





The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.





Best of luck!





Dr. SchwartzBoard Certified Plastic Surgeon



#RealSelf100Surgeon



#RealSelfCORESurgeon

Hello,There is very little difference between these two sizes. Placement can change how they sit/look. Your existing tissue and anatomy will determine where your Plastic Surgeon thinks they should be placed. Be sure to communicate your goals and expectations clearly. My patients find it helpful to try on the implant sizers in the office with a form fitting T-Shirt in order to get a feel for them.All the best

The difference is implant positioning.  Only about 50% of your implant will be sub-pectoral (deep to the pectoralis major muscle) if "under" the muscle.  This may diminish the incidence of capsular contracture for you, and as other responders suggest, camouflage implant edges better, so they'll be less visible when your swelling dissipates.  The type of implant used affects implant edge visibility and rippling though.  Form stable implants don't ripple if placed in an appropriately sized pocket, and can therefore be positioned subglandular with less concern about implant edge visibility and rippling.  These are questions and issues to resolve with your surgeon prior to your procedure.  The difference between 600 and 650cc in volume is just over three tablespoons.  From the standpoint of implants in your body, where is this 50cc difference distributed, in width or in projection?  Dimensions are much more important than volume when deciding upon implant size.

50cc is less than two ounces, I do not think you will notice a significant difference in those two implants.  Many people will advise you to go larger because patients will often say they wish they had gone larger. In my opinion going smaller makes sense, especially with very large implants.  Less weight on the tissue gives you a better long term result.  Also, under the muscle provides a more natural result with  a better long term result, in my opinion.  Good luck, Jane. 

Thank you for your question.  Given your height and weight, I think a 600cc or 650cc implant will be very large for you.  Regarding the placement of the implant above or below the muscle, I think either position can give a very natural look.  It really depends on how much native breast tissue you have, to conceal the implant.  There have been some well done studies demonstrating a slightly lower risk of capsular contraction or with the implant being placed below the muscle, however the downside to beneath the muscle is the risk of animation deformity and lateral displacement of the implant overtime.  Good communication, with your board-certified plastic surgeon where your expectations are clearly conveyed through the use of pictures, and an opportunity to try on different breast implant sizer's can be very helpful.  Your plastic surgeon will take measurements of your breast, determine how much of your own breast tissue you have, and discuss the most appropriate position for the implant, weighing the pros and cons of each position with you.  The 'look' you are hoping to achieve (for  example, more upper pole fullness) should be carefully discussed with your plastic surgeon.  Ultimately, when you are down to one or two sizes as it seems you are, give your plastic surgeon the freedom to place different sizers within the breast pocket created at the time of surgery and determine which size will look best for you.  It really comes down to excellent communication between you and your plastic surgeon.  Clearly convey your expectations and concerns  and don't be afraid to seek a second or third opinion.  Good luck!