What is the Difference Between over the Muscle and Under the Muscle Breast Implants?

Doctor Answers 17

Under muscle vs Over muscle

I would say that most plastic surgeons in the United States place breast implants below the muscle or submuscular. I favor this position as well in most cases. The muscle under the breast does not completely cover the implant.  It covers the top half or maybe the top third of the breast implant in most cases.  Some plastic surgeons refer to this position as partially submuscular, which is more accurate.  In some cases, it is referred to as "dual plane" which is another variation.  They all serve the purpose of providing additional coverage over the breast implant which is especially important in the upper chest to give a smooth transition in the upper chest/breast area.  Also it will prevent visibility of the implant and helps to camouflage rippling and wrinkling of the implant. This is especially important in women with low percentage body fat.

The downside is more discomfort after surgery, which I have not found to be an issue; the possibility of movement of the breast implant with contraction of the muscle which is rarely a complaint unless the movement is significant and the woman is a body builder who competes. Mammography may be facilitated if the implant is under the muscle.

The alternative is over the muscle or subglandular. This may be reasonable in women with more breast tissue and/or greater percentage body fat since they have more tissue for coverage of the implant.   Also, some women with a mild degree of droopiness of the breast may benefit from the subglandular position. (In some cases the dual plane technique is used for this purpose as well.)

There can be less discomfort after the subglandular procedure.  There is a slightly greater chance of capsular contracture with silicone breast implants over the muscle.

Thank you for this question and I hope you find this information helpful and good luck.


Fort Myers Plastic Surgeon
4.8 out of 5 stars 57 reviews

What is the Difference Between over the Muscle and Under the Muscle Breast Implants?

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement.

Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later.

Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.

Hope that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Both options have advantages and disadvantages...

Implant placement relative to the pectoralis major muscle continues to be a source of controversy.Although the majority of plastic surgeons prefer submuscular placement, there is still a large group of plastic surgeons who feel strongly about subglandular placement.Each group can make convincing arguments regarding their position of choice.It’s safe to say both approaches have advantages and disadvantages.
In the context of these discussions, we feel that every patient needs to be considered individually.Each patient has unique anatomic findings that affect the decision to place the implant under or over the muscle.The aesthetic goals of the patient are equally important and have a significant impact on the decision as well.The vast majority of patients are striving for larger breasts with a natural look.They want balance, harmony and proportion with the surrounding structures.
The majority of breast implants are placed in a submuscular position.There are several advantages to this approach.These include more soft tissue coverage which results in fewer visible folds, creases and ripples in the implant.This is especially important in women who have thin skin and minimal breast tissue who want saline implants.
Another advantage of submuscular placement is a lower incidence of capsular contracture.This phenomena results in hardening and distortion of the breast.Patients can also have significant pain with capsular formation.Capsular contractures can occur with the implant in either position but the incidence is higher when the implant is placed on top of the muscle.For these reasons, submuscular placement gives a more natural look in most areas.
Placement of the implants on top of the muscle should be considered in female body builders who have large muscles which can distort the implants during contraction.In women with breast sag, implants can be placed on top of the muscle to avoid a breast lift and scarring.
Every patient should be considered individually.It’s important that you meet with a board certified plastic surgeon who can help you obtain your aesthetic goals.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 193 reviews

Breast implants over or under the muscle

Thank you for your question. Breast implants under the muscle make it somewhat easier to get mammograms and have a slightly lower incidence of developing a hard scar. The muscle can also pad the implant in thin women to avoid severe rippling.  Women who have enough of their own breast tissue may be a candidate for over the muscle because their own tissue will pad and cover the implant making it less noticable. Both techniques are acceptable but selecting the right technique for the right patient is key. Implants under the muscle do bounce and jump with exercise.  I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 177 reviews

What is the Diff Between over the Muscle & Under the Muscle Breast Implants?Answr

I usually tell my patients that under the muscle gives you a more "natural" look and over the muscle gives more of a "wow" look. Under seems to have less hardening issues but it does have the "Animation effect" where the bottom of your breast tightens with pec flexion. Here in the states we do mostly below and in Brazil mostly above. There are some cases that really do need above the muscle but they are not as common.

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 41 reviews

Breast Implants over or under the Muscle?

The positioning of breast implants above or below the pectoralis muscle is a decision that will likely influence the outcome of surgery from most patients who undergo breast augmentation surgery.  The submuscular positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. As you can tell from this description,  I prefer the use of the sub muscular ( dual plane)  for most breast augmentation patients. I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,460 reviews

Difference between Over and Under the Muscle Breast Augmentation

No breast implants are perfect. A common weakness of ALL breast implants is their forming folds and rippling. To hide these ripples well, the woman's chosen implants are measured to be f a diameter which is covered by her current breast tissue. If this is ignored and an "A to a full D" augmentation is performed, ONLY the top of the impant is covered by breast tissue and te entire periphery and it's ripples are visible and palpable along the entire 360 degrees circumference. 

Placing the breast implant under the muscle under the breast  maximizes the amount of implant coverage and maximally reduces ripple visibility. In addition, placement under the muscle is associated with  a lower ncidence of hard scar formation around (capsular contracture) around the breast implants. 

Peter A Aldea,MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 105 reviews

What Is The Difference Between Over The Muscle And Under The Muscle Breast Implants?

There are different benefit and short coming with both submammary (over the muscle) and submuscular augmentation. The recovery is usually faster and has less pain initially for submammary implant. The submuscular (under the muscle) implant has the benefit of thick, soft tissue over the implant and less likely have visible or palpable implant. The implant tends to be higher initially after surgery but usually settle after a few months.

Colin Hong, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 38 reviews

Submuscular Placement Is the Most Popular Placement

Thank you for your question. Below I've provided descriptions of each of the breast implant placements. If you'd like more detailed information and a diagram to explain the different implant placement options, you can take a look at my Guide to Breast Augmentation on my website in the web reference below.

Submuscular implant placement: Dr. Zuckerman would make the pocket completely underneath the pectoralis major muscle. It is the most common placement he does, and it is also the most common placement for breast augmentation nationally. It is a simple placement, with a relatively bloodless dissection plane upon implant placement. This placement puts good tissue over the implant, and there is some thought among plastic surgeons that is creates less propensity for capsular contracture.

Subglandular implant placement: Dr. Zuckerman would make the pocket underneath the breast gland but on top of the pectoralis major muscle. This placement has fallen out of favor somewhat, but it is a matter of preference for the surgeon. If the patient has a very muscular chest wall such that when flexing, the implant may move significantly, Dr. Zuckerman might recommend avoiding the submuscular placement and to use sublandular. To some extent, this is also true for those with very little starting breast issue. This is the original implant placement location and was favored in the 1980's.

Dual-plane implant placement: Dr. Zuckerman would make the pocket under the pectoralis major muscle, similar to a submuscular placement, and then free up the interface between breast gland and the muscle so that the breast implant slides. In this placement, the breast implant contacts the bottom part of the breast gland, which hinges the breast mound & tissue to give a little bit more of a lift out of your augmentation. There are three variations of this technique depending on how much of the interface vertically is freed up, and which variation to choose depends on how much lift you would like to achieve. However, this placement cannot be used in place of a mastopexy.


Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 18 reviews

Breast Implants: Over or Under the Muscle?

This is a very important and very common question.  The overwhelming majority of plastic surgeons currently feel that placing the implants below the muscle has advantages.  They fall into two categories.  First is a health category, where at some point in a patient’s life, she will need to have mammograms performed for breast cancer screening and it is easier to get a high quality mammogram of the entire breast if the implants are below the muscle.  From an appearance standpoint, there is generally a more natural appearance in the upper pole of the breast if the implants are placed below the muscle.  (If you put them above the muscle, there is a greater likelihood of seeing an obvious shelf where the implant ends in the upper pole.)  Placing the implants under the muscle softens this area and makes it look more natural, while still giving upper pole fullness as desired.  A third consideration is that the incidence of developing a hard capsule (capsular contracture) in the breast is felt to be less likely if the implants are under the muscle.  Overall, breast implants under the muscle, is the winner.  

Richard A. D’Amico, MD, FACS
Englewood Plastic Surgeon
4.9 out of 5 stars 22 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.