What Type of Breast Implants Should I Get and Where to Place Them? (photo)

21yrs. I breast fed my child 3years ago. First Dr told me he would do it over the muscle to fill it out. I really wanted under muscle I went to a second doctor and he told me he would place the top of the implant under the muscle and the body over. Forgot what the proper name is called. He said he would release the breast tissue (i think he said) so it would drape the implant? The first doctor didnt even offer that. I would like more opinions from doctors and where i should place the implant.

Doctor Answers 12

Submuscular Placement for Thin Superior Pole in Breast Augmentation

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

   For most patients, submuscular placement is better as this provides better camouflage of the implantDual plane is characteristic of any submuscular augmentation as the implant is covered by both muscle at the superior extent and breast tissue at the inferior extent.

Treatment plan

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

Based on your photos, you will likely benefit from two different implant sizes to compensate your volume asymmetry. I generally prefer a dual plane technique.  In terms of size selection, I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.
Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.
Hope this helps.
Dr. Basu
Houston, TX

Under the muscle recommendation

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

A breast augmentation under the muscle would be a good option for you. I almost never place implants over the muscle, as long term outcomes are often sub-optimal. The release can be done to try to help round out the lower breast as your second doctor was speaking about (dual plane). A small lift may also be recommended to tighten your tissues and give you a more optimal result, however, this would entail more scarring and you are young. Good luck with your decision!

Breast augmentation versus breast lift

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


Thank you for the question and photo.  A breast augmentation increases the volume of the breast while a breast lift tightens and re-positions your current breast tissue.  It appears that you may benefit from a breast lift since some of your breast tissue and part of your areola is below your breast fold.  If you would like the implant placed under the muscle I would also recommend discussing a breast lift (circumvertical, aka lollipop breast lift) with your plastic surgeon.  It sounds like you may need to obtain a few more consultations with well trained board certified plastic surgeons.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

Submuscular breast implants placement biplanar or double plane technique

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

i believe there was a misunderstanding with the firs doctor counsultation. they both advised  waht is called a double plane technique, where the pectoralis muscle is cut inferiorly, partially medially and lateraly to allow space for placing top of implant.the lower part of implant will be covered by the gladular tissue, which is molded to give enough tissue covering.

this is the biblanar or double plane technique.

wich i think is a good option to sustain the breast tissue in and longer period.


Alberto Di Giuseppe, MBBS
London Plastic Surgeon

Implant pocket

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

Implants can be placed subglandular or subpectoral with release of the muscle so that the implants upper pole is covered by muscle and the lower pole is covered by gland.   This submuscular approach gives more soft tissue coverage in the upper pole.

Breast Implant Placement above or below the muscle

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Based on your consultations it sounds like both plastic surgeons felt that placement of implants completely under the muscle may give you suboptimal results. The first suggested placement entirely above the muscle. The second surgeon sounds like he recommended placement of the implants in a dual plane position. The dual plane position would allow muscle coverage for the top half of the implant and soft tissue coverage for the bottom half. There are many pluses and minuses to the various implant placements that are available. It's best to find a plastic surgeon who you are comfortable with who will take the time to discuss all of the options to help you determine which approach would be best suited for you. 
Thanks for your question and photos. Best of Luck!

Over or under with breast implants

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

In general submuscular augmentation will hide the implant best and prevent show through over time, and significantly reduces the risk of capsular contracture. Therefore most breast augmentation is submuscular. There are reasons to go over, especially if the size you choose is small and a subglandular implant would marry better with the natural breast tissue. You might need another exam and opinion to help you sort things out.

Breast Implant - Over or Under Muscle

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


I can't tell for sure from your pictures, but if the nipple position is  below your breast crease, a breast lift may be a consideration.

If you don't "need" a lift, then placement recommendations will vary from PS to PS.

  • Based on my experience, the "under the muscle" position is reasonable: The implant is never completely under the muscle. This is because the lower portions of the muscle (pectoralis major) are released so the implant can settle in the proper position.
  • So, the upper portion of the implant is under muscle, but the lower portion is not.

Thanks for your question and good luck!


Stephen M. Lazarus, MD
Knoxville Plastic Surgeon

Breast Implant Placement

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

It appears that you would benefit from a breast lift along with implant. The shape of your breast would be better with less overlap of skin on the bottom. The advantages of placing the implant either partly or completely under the muscle are more natural shape, less risk for capsular contracture, and better coverage of the implant. The dual plane technique (part under part over) would have more risk for being able to see the cut muscle edge when you flex or activate your chest muscle. In my opinion, the advantages weigh in favor of covering the implant with the muscle (under).

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.