Under or over the Muscle Saline Breast Implants for 32AA?

I'm 25. No kids, 5'5" and weigh 120 lbs. I work out regularly so have quite a bit of muscle and am also a runner. My current size is 32AA. I have picked a dr and am having my augmentation on the 17 of this month. I don't want porno boobs so I just went with 325cc of saline. He says I should go over the muscle. I've been reading on here that under and muscle better for small framed girls. I terribly afraid of this turning out bad. I don't want "ball in a sock, ripples or Capsular contracture! Help me decide!!!

Doctor Answers 22

Slender Women Have Better Results Under the Muscle

A slender woman needs more tissue coverage over breast implants, especially saline.

I strongly recommend submuscular placement of your implants, especially saline implants of the size you are considering.

Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

Don't go over the muscle with saline implants

Some of the worst results that come to me for correction are from over the muscle saline implants in thin women.  The results look poor, the implants are edgy, and often they are overfilled and hard in order to minimize their wrinkly nature.  Go submuscular all the time, especially with saline. 

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Over or under breast augmentation


You will obviously find differences of opinion about this topic between different plastic surgeons. I am personally a big believer in placing implants partially under the muscle for better upper and middle implants coverage (especially in the thin patient) and I believe it provides more support to the upper breast shape. This having been said, I do not have the benefit of examining you and reviewing your anatomy. I would discuss with your plastic surgeon why they recommend that approach over partially under. Best of luck.

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Under or over the Muscle Saline Breast Implants for 32AA?

 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 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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Above or below muscle breast augmentation

Implants can be placed either above or below the pectoralis major muscle, and each can have its advantages and disadvantages.  If the breast skin is very loose a subglandular (above the muscle) implant may fill out the breast better.  If one is very thin and wants a more subtle look a submuscular augmentation may be the better approach.  Capsular contracture can occur in either case but the risk is slightly lower in implants placed beneath the muscle.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Under or over the muscle

Lee- Most of the time, I choose to go under the muscle because it provides more camouflage for rippling because there is more breast tissue on top of the implants. You may already know that saline implants are more prone to show rippling and because of your stature and current breast size, it does not sound like going over the muscle would hide any of that rippling. Talk to your doctor about the possibility of going under the muscle and ask him what the difference would be.

Joseph G. Bauer, MD, FACS
Atlanta Plastic Surgeon
4.3 out of 5 stars 23 reviews

For you, saline implants will do best under the muscle

For women such as yourself who are trim and don't have an abundance of tissue to hide implants, the best position is under the muscle. If your implants are placed on top of the muscle, you will have much greater risk of wrinkling or distinct palpability. A silicone implant would likely be acceptable on top of the muscle, but generally I think that even these do best over the long term in a submuscular position. If you ever need a secondary procedure such as a breast lift, the operation will be safer as the breast tissue has remained attached to the underlying muscle with an abundant blood supply with less potential for healing problems.

Michael D. Yates, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 10 reviews

Breast Implants over or under muscle

For the majority of women, I prefer to palce implants under the muscle. More specifically in a biplanar poistion. This gives more superio coverage than just subglandular. In a thin small framed person, I feel that this is the best way.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Don't place your breast implants over the muscle

This is becoming a more common question. There are some advantages of placing the implant over the muscle, and in some cases is recommended. But not in yours. You are young, have little breast tissue, and going with saline implants. These are all reasons to place your implants under the muscle. I strongly recommend you get another opinion. Is your doctor a board certified plastic surgeon?

Dean Fardo, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 13 reviews

You may do better with silicone implants

If you do work out your pectoralis muscle and do not want to see implant moving with the pectoralis muscle contraction, consider silicone above the muscle. The placement of saline implant above the muscle will cause rippling and visible implant line later. Discuss your concerns with your plastic surgeon..

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 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.