Deflated breast, 36 c. Should I go above the muscle or under? (Photo)

Looking to be filled out again on top after breastfeeding took a toll. consult was to go over the muscle. Just interested in hearing other's thoughts as well. She also said I was just at the line to where I could do it without a lift which I would rather not have.

Doctor Answers 14

Above or below the muscle?

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Your photos illustrate a mild degree of droop that may be completely corrected with implants alone, providing that sufficient volume is inserted. As long as you possess enough soft tissue coverage beneath the chest wall skin, then the implants can be positioned above the muscle. This should provide you with several advantages: shorter recovery time to return to work-outs; less post-operative pain; and perking up the breasts which appear drooped right now. It is possible that you won't need any lift at all for now once implants are placed. Plan to consult a Board Certified plastic surgeon who can demonstrate plenty of experience with your type of breasts.

Suffolk Plastic Surgeon
5.0 out of 5 stars 18 reviews

Under the muscle

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Hello and thank you for your question. You are a great candidate for a breast augmentation.  I recommend under the muscle.  This has a lower rate of capsular contracture and less rippling than over the muscle.  Additionally, a dual plane technique can provide lift for your breasts.   The size 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.  

Best wishes and good luck.

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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 172 reviews

Implants above the muscle are a short-sited answer

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The idea that a subglandular implant will just fill in your skin is flawed.  It will also create more interference with mammograms, increase your risk for capsular contracture, be more visible and more palpable, and may sag off your chest causing a "rock-in-the-sock" deformity. A reasonably sized submuscular implant placed with a "dual-plane" technique will give you a good, long-lasting result and likely not require a lift.  Get another in-person opinion. Good luck!

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 17 reviews

Deflated breast, 36 c. Should I go above the muscle or under?

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There are many benefits to you by placing the implant under the muscle. You will have more natural looking cleavage because the implant will not be visible. You will decrease your risk of developing a capsule, which is excess scar tissue that can make the breast feel firm. You will also get a better mammogram when you reach that age where screening exams are indicated. Based on your one photo, I would suggest going behind the muscle. You will get some mild elevation of the nipple. This should give you a very attractive appearance without the need for a lift. Good luck!

Should I go above the muscle or under with breast implants?

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Thank you for the question. I think, based on your post, that one of the most important decisions you make is whether or not to undergo breast lifting surgery also;  hopefully, you will spend a significant of time  thinking about the pros/cons associated with each surgical option (and use your plastic surgeon as a resource as you do so).

 Generally speaking, 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 with your upcoming surgery.

Implant position

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Thanks for your question. It seems like you would have enough of your own tissues to hide an implant above or below your chest muscle. It may help to provide a bit more of a lift of the tissues at the same time. A true breast lift (mastopexy) could always be performed at a second stage if you desired. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 8 reviews

Implant placement location

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Thank you for your interesting question. 

Given the amount of soft tissue coverage that you appear to have, you could likely go under or above the muscle and achieve nice results. Both positions have their advantages and it is very important to spend an adequate amount of time with a board certified plastic surgeon who specializes in breast surgery to discuss what is best for you, given your anatomy and goals.  I place the vast majority of implants under the muscle, as the studies and my experience support this for most patients ( lower contracture rates, lower rates of rippling, better mammogram visibility, etc.). However, there are certain instances where above the muscle can be best for a particular patient.   

Please take your time consulting with a well-trained surgeon who is well versed in both techniques,  so you may choose the best operation for YOU.

Best of luck

Justin M Jones, MD

Jones Plastic Surgery 

Justin M. Jones, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 49 reviews

#abovemuscle #belowmuscle #implantplacement

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As you can see by these answers, there are options. The choice is more complex than just above or below the muscle. These include sub glandular, sub facial, partial submuscular (biplaner) and total submuscular.

There are definite advantages and disadvantages to each of these options. My advice is to see a plastic surgeon that can discuss the pros and cons of each option. In your situation, looking at your pictures, you would appear to have adequate soft tissue coverage and I think subfacial placement would be your best option. Particularly with the pseudoptosis (droopiness) that you have. Obviously, I would need to examine you for a definitive recommendation.

Jack Peterson, MD
Topeka Plastic Surgeon
4.6 out of 5 stars 47 reviews

Above or Below

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I think the choice to go above the muscle is a good one.  You've got a C cup's worth of volume to disguise the implant and will still have a natural upper pole.  The biggest advantage I see in going above the muscle is that the implant will provide more defined shape to the borders of the breast which appear to be ill-defined now.  You will also have less discomfort and a quicker recovery and final result.  Going above the muscle is a good plan!  Best wishes!!1

Levi J. Young, MD
Overland Park Plastic Surgeon
4.8 out of 5 stars 73 reviews

Deflated breast, 36 c. Should I go above the muscle or under?

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Most experienced surgeons taking care of a patient with your anatomy will recommend under the muscle with a dual plane technique for implant placement. A lift is OK but not necessary for good results. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 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.