Under the Muscle Vs. over the Muscle?

The key word in your post is "saggy."  You did not include a photo so let's go by that description.  Implants alone will add volume to your breasts but they will not lift them.  That requires a breast lift procedure. If you are saggy and you put implants under your chest muscle then the implants will sit too high on your chest wall.  If you place them above the chest muscle then they will settle down to where your breast tissue is located.  Then you will be larger but still saggy. If that would make you happy then that would be an option for you.  If you are truly saggy, however, and you want a perkier look to your breasts then I would suggest a breast lift with or without implants placed under the chest muscle.  The trade-off would be additional scars to the breasts.  Bigger and still saggy or perkier with more scarring?  That is the question you need to consider.

Unfortunately, you have not provided any photographs but describe yourself as a saggy B.  If the implant is placed in front of the muscle, the additional weight will stretch the saggy envelope even more and you will be dissatisfied.  There is a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Through the same incision, implants can be placed.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. 

 

Best Wishes,

 

Gary Horndeski, M.D.

It is impossible to tell without a picture but i like under muscle +- a lift. The muscle helps to hide the implant and prevent rippling. Over the muscle is not the wrong choice, just another opinion.

Hello there and thank you for your kind question

The key term you used here is 'saggy' and as I am sure other surgeons will mention, if you do not have an associated uplift to cope with the excess skin you may have a less than ideal result if you go under the muscle. You obviously have an expanded skin envelope following breast feeding and this needs to be filled out adequately. The best way to do this is by going on top of the muscle. I am sure your surgeon has also discussed the limitations of this method too. Good luck!

Paul Banwell

You have a lot of options when restoring breasts after pregnancy and breastfeeding.  Without seeing you, or at least a photo, it is hard to tell which option would be best for you.  Because you mention sagging, I would encourage you to explore your breast lift options in addition to breast augmentation.  In general, if you have sagging breasts and a breast implant is placed under the muscle WITHOUT performing a breast lift, you will be left with a double bubble - the implant will sit securely under the muscle and then your breast tissue will continue to sag below.  Placing an implant on top of the muscle without a lift allows you to increase volume, avoid the double bubble, but will NOT correct the sagging.  Additionally, breast implants placed on top of the muscle are usually more visible, more easily felt and they can interfere with mammography.  I try to avoid placing implants over the muscle (subglandular) whenever possible.  A dual plane approach is a nice "happy medium" for many women with MINIMAL sagging (usually women whose nipple is at - not below - the inframammary fold).  With the dual plane approach the implant is placed partially under the muscle, but the lower portion of the pec muscle is freed from the chest wall allowing the implant to settle nicely into the breast envelope.  If you have more than minimal sagging, a breast lift with implant (augmentation mastopexy) may be your best option to create firm, perky breasts with increased volume.