Under the Muscle Vs. over the Muscle?

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.