Breast Augmentation - under or over the muscle - which is safer?

Doctor Answers 15

Under vs over the muscle

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Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

No right way, you need to make an informed and balanced judgement

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Hello Sophie, you will see from the answers here, that there is no one best way to do the surgery.  There are pros and cons of putting the implants under or over the muscle and you need to weigh up these risks and benefits in light of your own circumstances to make an informed decision.

I have recorded this short video that might help.  Good luck.

Breast Augmentation - under or over the muscle - which is safer?

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    over or under muscle doesn't dictate what size implant we can use.  The muscle coverage is helpful in very thin patients and seems to reduce capsular contracture according to some scientific studies. Under the breast tissue is the most natural feel and has a less chance of animation deformity when the pectoralis muscle contracts. In most instances only the top implant is covered by muscle and the reset of the implant ends up under the breast tissue.

High profile are taller and narrower implants when compared to moderate profile implants of the same volume.The decision is usually based on the patient breast dimensions, amount of breast that the patient can contribute to the projection and I also factor the patients desires. I try my best to also respect the skin quality and elasticity in order to prevent future drooping due to unnecessarily heavy implants.

  What are the basic tips to know if I need a breast augmentation or breast lift? It all depends on the position of the nipple on the breast. The further down the nipple is in relation to the fold the more the chances are the patient needs a lift.

Choose a board certified plastic surgeon who has done a ton of Breast Augmentation and has privileges to do this surgery at a local university hospital. This says his credentials have been checked out by fellow Drs. All surgeries carry risk, talk to your plastic surgeon and choose one wisely.

Many surgeons, including myself, offer online virtual consultations where you send us your photos and we can estimate the cost. I, like many surgeons, also offer free consultations so that you can be examined and given the most accurate quote possible. Please be mindful that the in person physical exam is the most important and could potentially alter your treatment plan.

Breast Augmentation-Over or under the muscle- Which is Safer

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Dear Sophie:

Both are safe. There are advantages to both depending on what implant you choose and whether the skin envelope is normal or not. The sub glandular space is ideal for women with a bit of sagging but not enough to warrant an actual surgical lift. The partial sub muscular pocket is best in patients with very little tissue in the upper pole because the muscle tends to fill the area out and prevent palpability of the implant edge. Nowadays another advance would be to fat graft the upper pole and implant into the sub glandular pocket. This technique is good for minor asymmetries and deepening the cleavage. 

Thanks for the great question,

Dr K Dolynchuk

Ken Dolynchuk, MD
Manitoba Plastic Surgeon

Safer under the muscle?

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There is no simple answer to this question, I'm afraid and you really can only make an informed decision after a consultation with a reputable surgeon that you feel comfortable with. I have found 3-D imaging extremely useful in showing patients what is achievable and would suggest you try and find someone in your area who can offer this. Overall, there are no safety issues with either technique and you need to weigh up the relative cosmetic  pros and cons before making a choice. Good luck.

Breast Implants are Extremely Safe Under or Over the Muscle

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Hi Sophiea,

Thank you for your question.  The quick answer is that breast implants are extremely safe and have an extremely high satisfaction rate when you chose a plastic surgeon that has extensive experience and a great safety record.

The desire to go under the muscle is usually to create a more natural look.  The implant has the muscle and the breast tissue over the top part of the implant.  It has a softer upper pole and the breasts often look "too good to be true" but not like they have been implanted. 

If you go over the muscle the breasts will often have a very round upper pole and look "like implants".  This is especially true in very thin small busted women.

The best decision you can make would be to see a PS in your area that has an excellent reputation for surgical outcomes and excellent pre-op and post-op care.  Spend the time to meet him / her and learn about breast implants.  Do the sizing, chose the implant size / style / gel type that meets your goals and desires.

Only after a comprehensive consultation will you be able to make the decision that is right for you.

I hope this helps.  You will be very happy for years with your new body shape. 

All the best.

Scott K. M. Barr, MD, FRCSC

Scott Barr, MD
Sudbury Plastic Surgeon

Breast augmentation

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Hello and thank you for your question. 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.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

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

Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision

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I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  

Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Breast Augmentation

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Thank you for your question. I perform breast enlargements on top and below the muscles. It takes me the same amount of time to perform a breast enlargement going on top or below the muscle. I lose the same amount of blood (which is typically a teaspoon or less). My success rate is the same. When going on top of the muscle I like the patient to have good soft tissue thickness to the breast. If the patient has very thin breast I prefer to go under the muscle. When going on top of the muscle one typically has very little to no breast animation. Breast animation is where the breast implant bounces up and down when a patient flexes their pectoral muscles. During your consultation I like to find out your goals (I.e. What cup size you would like to be). It's important to measure the width of your breast to determine which implant you need. I use the bloodless breast technique which I invented. Bleeding is minimal, typically there is no bruising after surgery, and recovery is quicker versus traditional technique. I hope you find this helpful and for more information please see the enclosed video. 

They are both safe

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Consideration of implant position is one that is determined on a case by case basis. There are certain tradeoffs between the two. Under the muscle, there is good evidence showing a lower risk of capsular contracture than an implant above the muscle. In certain patients the overall aesthetic look may be better achieved with the implant above the muscle. A woman's breast tissue lies above the muscle. If a patient has adequate soft tissue coverage and is a good candidate, I counsel the patient about the advantage of placing it above the muscle in order to achieve a specific look.  In my practice, over 90 % of my implants are placed under the muscle, because many of my patients have had children with postpartum deflation. In these case implants are better served below the muscle. In the young nulliparous woman with adequate soft tissue I give consideration for implants above the muscle. I also perform a Dual Plane breast augmentation in which a portion of the implant is placed below the muscle and a portion is placed above. This provides the best of both worlds. I recommend being seen by a board certified plastic surgeon who performs many cosmetic breast procedures to be evaluated.

Best wishes,

Dr. Ravi Somayazula

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.