Help! 28 year old mom of 2. Over or under the muscle placement? (Photo)

I have had consultations with 3 different board certified plastic surgeons who all have excellent reputations,and are all top surgeons on real self. All 3 agree on size and type of implant but 2 of them recommend under the muscle placement and 1 recommended over the muscle. I don't know what to do.should I go over or under?Please share you expertise with me. Thank you

Doctor Answers 12

Help! 28 year old mom of 2. Over or under the muscle placement

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Without performing a lift to position your native breast tissue higher will not allow much,if any, of the implant to be below the muscle. The reason for that is we try to place the implant evenly behind the nipple and as your nipple is set low, the percentage of implant below your muscle will be less.

Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Under or over the muscle?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I elect to do submuscular placement for about 99.9% of my patients.  They will absolutely look and feel more natural that way.  The recovery is a bit more difficult, but in my opinion, worth it.  Good luck!

Over or under the muscle implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If I were in your position I would follow the advice of the surgeon who you choose to operate on you.  You will probably get results with either technique.  I think a lot depends on what implant you are selecting.  With a smaller implant it's okay to go above the muscle and it will fill out some of the deflated breast tissue.  If you're going with a larger implant then under the muscle would probably be better.  I hope that helps.

Adam Hamawy, MD
Princeton Plastic Surgeon
4.8 out of 5 stars 57 reviews

Over or under the muscle

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

From your photographs, it seems that going under the muscle may be beneficial for you. Because you don't have much breast tissue to start with, going under the muscle will likely be very beneficial to hide any potential rippling.

Ira H. Rex lll, MD
Fall River Plastic Surgeon
4.7 out of 5 stars 52 reviews

Breast Implant Placement Above or Under Muscle

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are advantages and disadvantages of placement of breast implants both above and under the muscle. I would say that most surgeons choose most of the time to place the implant under the muscle, and, if there is no reason to choose over the muscle, this is the best placement according to most studies. However, there are 3 major reasons to put the implant in the sub-glandular position. One is if you are very active and use your arms a lot. In this group, placing the implant below the muscle leads to problems with use of the arms, the implant bouncing when using the arms, deformity in many sporting outfits when doing those sports and discomfort. Because my population is very active, almost all of my implants are above the muscle. The second reason is, if you have a slight droop, it is easier to correct with a supra-muscular placement. Thirdly, if the muscle edge is high, the implant is best placed above. You did not say anything about your arm use, but, from your picture, you may fit the second reason. If you choose over the muscle placement, which, in the proper hands, gives a very natural feel and look, make sure the implant is textured as this makes above placement as safe as below placement. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Above and below the muscle possible

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi there, thank you for your post. Based on your photos alone, it looks as if you have enough tissue for the implant to be placed either under the muscle or over. In addition to thickness of the breast and skin tissue, there are many other considerations in choosing the right implant pocket - need for breast screening, need for a simultaneous lift, desire for cleavage, speed of post-op recovery etc. This can only be covered adequately in a consultation but based on your external anatomy - either will work in your situation. Good luck!


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In the majority of my patients, I place implants under the muscle. I think it provides more soft tissue coverage for the implant in the upper pole.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Help! 28 year old mom of 2. Over or under the muscle placement?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have excellent breast anatomy and should achieve a very nice result.

There are so many advantages to placing the implant under the muscle, less chance of capsular contracture, less visibility of implant, and better long term appearance. I would not consider placing the implant on top of the muscle especially in a young person like you who will have these implants for many years.

Under the muscle

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello and thank you for your question.  You are a great candidate for a breast augmentation. There are several advantages and disadvantages to over vs under the muscle.  Under the muscle has the advantage of lower capsular contracture rates, less risk of rippling, and better visualization with future mammograms.  Most patients say that under the muscle also has a more natural look and feel.  The size, shape, and profile of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  This entire surgery can be performed with a small incision technique.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Over or under the muscle placement?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question.

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.

I think it is in the best interests of most patients (including athletes) seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position. 

On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in these sub muscular position.  Best wishes.

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.