Over the muscle vs. Under the muscle (Photos)

Question

I'm getting 340 cc natrelle high profile in a couple weeks. My PS suggested over the muscle but I'm starting to get worried 90% of the reviews I read had under. He said I have enough breast tissue to still have the natural look. Should I be okay with over or should I do under??

Aldo Guerra, MD · Answer

Hello and thanks for this question.I don't see any reason for you to go above the muscle. Based on your photos, you're a good candidate for breast implants. However, you should discuss this with your plastic surgeon. Perhaps, there's a good reason he knows about since he/she took a complete history and did a physical examination on you. We perform numerous breast augmentation procedures in Scottsdale. See the link below.Best wishes, Dr. ALDO

Marc J. Salzman, MD, FACS (retired) · Answer

Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a narrower cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery.

Over the muscle vs. Under the muscle (Photos)

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Everything you need to know about Natrelle Breast Implants

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Over the muscle vs. Under the muscle (Photos)

Answers (2)

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Everything you need to know about Natrelle Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.