Do on top of the muscle implants sag or look worse than under the muscle in years to come?

There's a misconception that the muscle holds up the implant better. The muscle is used as extra cover over the upper medial aspect of the breast to camouflage the implant. If you are slim, and have small amount of breast tissue, then placing them over the muscle will tend to show the outline of the implant. Saline implants, I believe, are harsher on the tissues and cause a traction pull phenomenon over time which presents itself as rippling and sagging breasts (often people wonder if their implants are leaking, since they look smaller in a stretched out skin envelope). See a board certified plastic surgeon for another opinion or re-consult with your present surgeon. Good luck.

Generally speaking on top of the muscle is a compromised outcome when compared to the under the muscle approach.

Tissue thinning and implant visibility tend to be more prominent with subglandular placement.Kenneth Hughes, MDLos Angeles, CA

Thank you for the question. Although breast implants in the sub muscular ( or dual plane) position may experience “distortion” with muscle movement (workout) I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” 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 in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction) is also decreased with implants placed in the sub muscular position.I hope this, and the attached link (dedicated to breast augmentation surgery concerns) helps.

will all settle and droop with time but its much more apparent when they are placed on top of the muscle.  They really look like 'rocks in socks' as you age.  If you're having the shaped gel implant, your body should heal around it and it should hold its shape well over the years and this is what I would recommend to my patients who want them on top of the muscle.

Hello Nenee thanks for your question. This is a common discussion when it comes to breast augmentation subglandular (on top of the muscle) vs. submuscular (under the muscle) which is "better" (other more complex aspects include discussions of "dual plane" etc).  You may find Plastic Surgeons who prefer one or the other method or who only perform subglandular or submuscular augmentation. I definitely perform many more sub-muscular augmentations but do feel as if their are some indications/patients who are candidates for subglandular implants.  One thing is even "submuscular" implants are only partially under the muscle (typically only the upper 1/3 to 2/3 depending on the configuration of your pectoralis muscle) meaning the lower portion of the implant is pretty much "subglandular" anyway.  There are aspects of submuscular implants that may be advantageous including a lower incidence of capsular contracture (this advantage is somewhat diminished with textured implants). Moreover patients who are thin or have smaller breasts often benefit from placing the implant under the muscle as it makes them look more natural and much less of a step off between the upper chest and implant. Some new shaped implants may make this less of an issue. Some patients with mild ptosis (mild drooping) may get a slight lift from a subglandular implant vs. a submuscular implant where as a submuscular implant with breast ptosis can sometimes lead to a double-bubble if the implant stays high and the breast drops "slides off the implant". That being said I do not try to perform a "lift" with an implant as I feel as if this will inevitably lead to worse dropping of the breast. To address your specific question it is difficult to say what implants will drop significantly over time, this depends on your skin elasticity, weight changes, pregnancy, etc. However, as one of the Surgeons mentioned being only a B cup your tissues may be so thin whereas the implant may be very visible in the subglandular position.  It is good to make sure your Surgeon is Certified by the American Board of Plastic Surgery.  I hope this helps and doesn't confuse the issue further. Best of luck, Regards. Dr. Joseph Eby

If your upper pole tissues are no significantly thick (and at a B cup I suspect they are not adequately thick) those implants over the muscle are liikely to look bad by 10 months, not 10 years.