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

I'm 41 yrs old, 5'8 and 140 lbs. not sure if that will be to big for my body frame. I want the fullness and I want cleavage. Appreciate your opinion?

Doctor Answers 18

Under or over the muscle. And is 600 or 650 cc better?

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Thank you for your question.

Please see several board certified plastic surgeons that can examine and speak with you about your goals.  They will measure your chest dimensions, amount of breast tissue, and nipple position among other things to develop a plan for your augmentation.  The volume of the implant is in my practice one of the least important part of the process as I value base width, height (if using shaped implants), projection, and saline versus silicone over specific volume implant.

The reasons to go under the muscle typically involve wanting to achieve better implant coverage as in patients with little breast tissue.  This approach is the more common approach, in the United States, but I would consider above the muscle or subglandular /subfascial to be regaining popularity.  Above the muscle placement has advantages of less pain and no animation deformity and possibly more of a lift effect.  Under the muscle which would likely be a partial submuscular or dual plane approach would allow more coverage in the implant particularly in the upper pole of the breast.  

A 600 or 650 cc may be an appropriate size for your frame but it is impossible to tell without an in person exam.  I can say from personal experience the difference between a 600 or a 650 implant is imperceptible by trained plastic surgeons and I would recommend not stressing over 50 cc.  Many surgeons when faced with that very question recommend the larger number to avoid a patient regretting not going larger.  A 650 cc implant would be in the larger category for primary augmentation in the United States where averages based on region are probably in the 300-400 cc range and trending downward.


Dr. L

Austin Plastic Surgeon

Breast Implant placement and size

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Thank you for your question. When considering breast augmentation, you and your Board-certified plastic surgeon have 4 main decisions to make: 1. the size of the breast Implant. 2. The choice of saline vs. silicone breast implants. 3. Whether to place the implants over vs. under the muscle. 4. The location of the incision. What determines where we place the implant? The chest muscle generally serves two purposes with regards to the implant. It provides additional soft tissue coverage, and it can help shape the upper portion of the breasts. When an implant is placed under the muscle, it puts some pressure on the implant and helps give the sloped look to the upper breast. Placing the implant under the muscle would be ideal for you to achieve a more natural look. The more breast tissue you have the better results you will achieve. The size can be determined with your plastic surgeon, as there little difference between 600cc-650cc.  Good luck to you and hope this was helpful. 

Michael K. Obeng, MD, FACS
Beverly Hills Plastic Surgeon

Breast placement and sizes

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There are pros and cons to the location of the implant. Benefits to putting the implant above the muscle is less implant movement with muscle contraction and easier surgical dissection. Benefits to putting the implant below the muscle is less scar tissue formation and less visible rippling from the implant. There are other reasons as well and some surgeons prefer one pocket to the other. In terms of sizes, a 50cc difference is very minimal at the 600cc level and it is best to allow the surgeon to decide which one looks better during surgery when the implants can actually be tested and placed. It is important to have a thorough examination and discussion with your surgeon prior to the procedure so that all your questions are answered and you can make an informed decision. Hope this helps!

Johnson C. Lee, MD Plastic Surgery

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 17 reviews

Under vs Over the muscle

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Hello and thank you for your questions. The best way to suggest the right implant size for your body frame would be to have an in-person examination with a board-certified surgeon. I generally suggest my patients to have the implant placed underneath the muscle for a more natural look and you will have less risk of capsular contracture.  

Peter Newen, MD
Orange County Plastic Surgeon
4.6 out of 5 stars 42 reviews

I prefer under the muscle if you don't mind the animation that will come with it...

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The implant can be placed either above (subglandular) or below (submuscular) the pectoralis muscle.  My recommendation is to place the implant under the muscle because the muscle provides added protection of the implant from superficial skin infections or injury, provides more accurate mammography when evaluating lesions with muscle between it and the implant, adds fullness to the upper pole, covers any upper pole rippling, and diminishes the risk for capsular contracture.  It will weaken your chest muscles and this usually goes unnoticed by most.  Placement under the muscle will result in visible movement of the breast mound with any contraction of your chest muscle. It may also deepen your armpit making shaving challenging. The one exception I have in placement involves body builders or others who are planning to flex their muscles in front of audiences.  Placement above the muscle diminishes the chance of implant movement with muscle flexion and is anticipated to hurt less and allow a faster recovery but it’s been my experience that subglandular placement can take on the “rock-in-a-sock” look or droop as time goes on (especially with smooth round implants). 

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision

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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. Schwartz

Board Certified Plastic Surgeon



Size and Placement

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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

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

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Simply put, the majority of breast implants these days are placed in a subpectoral position to create a more natural look with better mammographic detection of breast lumps.  Contraction of the muscle by athletes will cause an unusual temporary effect on breast shape but this is usually acceptable to most patients.  Over the muscle creates a natural look if you have thick breast tissue (and continue to maintain it as you age) and possibly has a higher risk of capsular contracture.  IMO above the muscle creates a more of an "in your face" type of look that some patients desire.

A bigger issue I believe is the size of implant that you seek.  Though it may fit your breast shape and skin and be proportionate for your body, it is well above the size of the average implant and may cause complications over time.  Think carefully about your size choice but whichever decision you make I hope that you enjoy your results for a long time to come.

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca 

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast Implants under vs over the muscle. What's the difference?

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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.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Large Implants

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Thank you for asking

Just based on your body measurements (mainly your height) 600cc's is not out of the question. Of course it depends on how wide your hips are as to whether these will look proportional. As for the cleavage it really depends on your naturally occurring cleavage preoperatively. I almost always suggest going under the muscle as it will give a more natural upper pole (fullness) of the breast. We would love to see you for a complimentary consultation in our Mission Viejo or Newport Beach office to go over all of your options. Or please feel free to message us with your photos and any other questions you might have. Thanks and best of luck! Dr. Kachenmeister, (Dr. K) MD.

Robert M. Kachenmeister, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 28 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.