Under the muscle of over for active lifestyle? (Photo)

Hi - is it best to go under the muscle or over? I plan to get back into training after my op so lots of pull ups, press ups and weight lifting. I'm feeling confused which one would be best for me - under or over? Any advice would be great, thank you.

Doctor Answers 5

Under the muscle of over for active lifestyle?

Thank you for the question.I think it is in the best interests of most patients (including athletes) 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 the sub muscular position. 

Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

I suggest under the muscle

 i think under the muscle definitely has the following advantages:1) feels more natural to whoever feels your breast.2) better mammograms since it pushes the breast tissue farther off of your chest wall.3) more natural look 4) less likely to develop hardness (capsule formation)
However, when you do things like bench pressing or pull ups, your implants will definitely shift 

David E. Berman, MD
Sterling Plastic Surgeon
5.0 out of 5 stars 109 reviews

Over or under the muscle for breast augmentation

 This is a very commonly asked question. In general the best position for the implant is under the muscle. For most  surgeons this means a dual plane augmentation  In my practice this means a dual plane augmentation with a living bra of muscle laterally using the Serratus anterior muscle . This holds the  implant in its proper position for a very long time. Drawbacks of placing the implant above the muscle are as follows: the implant is more likely to be visible and appear more phony and more round. There is more chance of wrinkling and rippling that is  visible because there is no muscle coverage. Without support from the muscle the implant is more likely to drop down quicker causing a bottoming out of the breast and the need for a breast lift in several years . I have many patients that are athletes runners CrossFit people bodybuilders who have implants under the muscle and do extremely well. Their implant longevity and breast shape longevity is excellent 

Andrew Kaczynski, MD (retired)
Sacramento Plastic Surgeon
4.9 out of 5 stars 110 reviews

Breast Implant Under or Over muscle for active lifestyle.

Thank you for your question.This is a common question and unfortunately there is no blanket answer for all patients.  There are pros and cons for both locations.For above the muscle (subglandular or subfascial) placement.  The implants should not develop any animation deformity with exercises which can be a significant issue with under the muscle location without adequate release of the pectoralis muscle.  There can be some concerns over visibility or palpable implants in thin patients.For under the muscle (total submuscular placement or "dual plane") the implant will have less chance to be visible or palpable.  This can still happen however in thin patients.  Rarely is an implant placed totally under the muscle and the "dual plane" approach is more commonly used. During this the upper portion of the implant lies underneath the pectoralis major and the lower part is subglandular.  Ideally this will prevent an animation deformity with contraction of the pectoralis muscle but there is typically a small amount of movement of the implants with arm movements.My recommendation is consult with a board certified plastic surgeon.  Only on an in person exam can a recommendation truly be made for your particular body.Best Dr. L

Andre Levesque, MD
Austin Plastic Surgeon
4.7 out of 5 stars 3 reviews

Under vs over implant placement

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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 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.