Over or Under the Muscle For Me? (photo)

I'm a 35yo 5' w/ 2 kids,1 was breastfed. I want my breast perkier without the scars of a lift, fill out my breast where tissue thinning, as well as have larger breast. I am currently a 38C and I am thicker in the middle & bottom so the bigger breast would help proportion my body. I met with a plastic surgeon who keeps suggesting over the muscle and another who suggest under only. So Confused! First 2pics are me,second 2 are what I want. I don't care if people know I have implants. What to do?

Doctor Answers 5

Implants under the muscle

If you already have droopy breasts from weight on your tissues that have lost the elastic fibers, why would adding more weight to this scenario not make them droop more over time?  If you put the implants under the muscle with droopy breasts, at least you are not adding weight to the system which would make them droop more.  The muscle separates the two, and keeps the implant from adding weight to the breast tissue.  Long term results will be better putting the implant under the muscle. 

Orange County Plastic Surgeon
4.8 out of 5 stars 33 reviews

Implant position, subglandular vs. submuscular

With your existing breast shape you will never get the "perky breasts" like you have shown in your example.  It is possible that a subglandular breast implant position may give you a bit more lift.  You would need an examination to make a final decision.   Other factors involved include how much breast tissue is below the crease and the exact position of your nipples.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Subglandular implants might be right for you

For some there will be a better marriage of the breast and implant in a subglandular position, and as your breast has substance and good cover, a subglandular gel might work out very well. Be cautious about the nipple position, but if you don't want the scar and can accept your shape the way it is you can get a very good result.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Over or Under the Muscle For Me?

Depending upon how much larger you want to be, I am not sure that choice of above or below the muscle is the key decision here, and either may be acceptable.

The big decision I see is your desire to have lifted breasts without have a breast lift. I understand the desire to minimize scars, but the scars are there for a reason-- to get the best possible result. 

The position of your nipples and areolae are low enough that an implant insertion has a high chance of leaving you with the appearance of your own breast tissue hanging off from the implant, and the only solution to that problem, short of removing the implant is a breast lift.

If the scars of a breast lift are out of the question for you, I would think twice about having a breast enlargement in the first place. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Over Vs. Under The Muscle Breast Implants

Please, please do not allow anyone to place breast implants over the muscle! Yes, they may look great for a while, but with time, your tissues WILL stretch and you WILL have a bigger problem than what you have now. I never place implants over the muscle for this reason. Also, do not be fooled into thinking that large implants will 'take up the slack' and lift your breasts. Implants do not lift breast tissue. I can understand your apprehension in getting a lift and associated scars. There is a technique, however, that does not require a vertical scar to effectively lift and secure breast tissue. The Ultimate Breast Lift was designed to provide women with upper pole fullness without implants. Breasts are high, round and are given a natural younger appearance with fewer scars. Incisions are hidden around the areola and the inframammary fold. Higher/perkier breasts often appear larger than what they truly are.

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 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.