Unsure of Best Implant Position for Me?

I am having a breast reduction and lift with implants in just under two weeks and as I am unsure where to position the implant, behind of infront of the muscle. My surgeon has described my breast as pendulous and asymmetical with the right breast bigger and more saggy. Since this initial consultation i have lost about 14kg an now weigh 82kg, I am 176cm tall. Can anyone help me?

Doctor Answers 4

What is the best implant position?

That is a questions frequently asked and as you have seen, the prior posters favor the submuscular position.  Submuscular to me means 'partial' submuscular as the implant is not completely under muscle and that is my preferred placement because of diminished risk for contractures, more fullness on top, minimal chance of visible rippling on top and better mammograms under the muscle.  You will have to accept the movement of your breast that WILL occur when you flex your chest muscles.  I believe the tradeoff is worth it but your should discuss this more thoroughly with your own doctor.


Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Above or below the chest muscle for implants

There are pros and cons to each position, however, I think most plastic surgeons and patients tend to prefer placing implants under the muscle these days.  It takes a little longer for the muscle to relax and soften up but I think the extra time is worth it.  I tend to have three reasons for preferring under the muscle placement:  1. the extra tissue coverage over the implant helps minimize the chances of seeing/feeling any ripples or wrinkles which might be associated with an implant, especially the saline implants.  2. the continuous movement of the muscle over the implant massages the implant and decreases the risk of forming capsular contractures, the thick scar tissue capsules that can form around an implant causing the breast to feel firm or become distorted in appearance.  3. there is some suggestion in the literature that it is easier to perform and to interpret mammograms when implants are below the muscle.  A lot of the blood supply to the breast comes through the chest muscle.  If you are having a breast lift and you place the implant above the chest muscle then it may disrupt some of that blood supply.  The downside of placing implants under the muscle (other than the additional time needed to settle) is that the implants may behave more like the chest muscle than the breast.  When you flex your chest muscle or lift something, the muscle may flatten out causing the implant to move in an unnatural way.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Implants above or below muscle

In general implants under the muscle have fewer complications and look more natural in the long-term. Placing implants over the muscle will look better early on but in time will cause more ptosis and visibility of implants. There are breast types that will do better with implants over the muscle. review the option carefully with your surgeon.

Shahriar Mabourakh, MD, FACS
Sacramento Plastic Surgeon
4.9 out of 5 stars 208 reviews

Above or below the muscle

Most surgeons in the US prefer subpectoral (under the pectoralis muscle) placement. Advantages include:

  • better upper pole appearance--more natural
  • fewer problems with capsular contracture
  • less chance of feel the implants or any ripples at their edges
  • better mammography

The disadvantage is animation, movement of the breast with use of the arms. 

Your surgeon will be in the best position to help sort through the pros and cons in your individual situation. A revisit is in order anyway with your significant weight loss, which could result in a change from the original plan.

Thanks for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 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.