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Breast Implant Placement: Over vs. Under The Muscle

Written by Cameron Craven, MD, FACS, Board Certified Plastic Surgeon on April 13, 2021 76 Comments

over vs. under muscle breast implants

Originally published on October 24, 2014. Updated April 23, 2021 with additional information

During a breast augmentation procedure, an implant may be placed either over the muscle or under the muscle.  Multiple factors play a role in determining the optimal implant placement for each individual patient, including patient health history, implant type, implant size, and the patient’s body type.

If you’re considering breast implants, you may have heard you can choose to place them over or under your chest muscles. Which is better for you depends on several factors, including your age, current breast anatomy, activity level, and tolerance for post-surgery down-time.

While an experienced plastic surgeon is in the best position to determine optimal implant placement, it is vital for breast augmentation patients to understand the benefits and drawbacks to each technique.  Learn more about which breast implant placement, over or under the muscle, is best for you.

breast implant position
(Image via Info Plastic Surgery)

Over the Muscle (subglandular) Breast Implant Placement

When a breast implant is placed ‘over the chest muscle’ it’s placed under the breast’s glandular tissue. This method is sometimes referred to as subglandular placement. Because the chest muscles, or pectoral muscles, are not manipulated in this procedure, recovery tends to be quicker and less painful.

You might choose over the muscle breast implant placement if you already have ample breast tissue and you’re looking for a moderate, natural-looking enhancement. Your natural glandular tissue will cover the breast implant, which minimizes the risk of implant visibility, rippling, wrinkling or folding.

If you lift weights, or participate in activities which strengthen your chest muscles, over the muscle implants are at less risk of distorting as your pectoralis muscles develop.

Pros of Over the Muscle Placement

Potentially quicker, less painful recovery

Surgical procedure is much easier and less invasive compared to under the muscle placement. Because your pectoral muscles stay intact during this procedure, your body will heal sooner, typically with less discomfort.

Larger implants are possible

When implants are placed over the muscle, there’s no limit to the size of the breast implant pocket that can be created. This means larger sized implants may be used. This method is thus preferred for those already at least a B cup who are seeking dramatic change.

Avoids dynamic distortion

Dynamic distortion is the lateral breast movement that occurs in some implants when the chest muscles are flexed. This type of movement will not occur when implants are placed over the muscle.

Better Cleavage

Generally, more cleavage can be created because the implants can be placed slightly closer together.

Can lift slightly sagging breasts

Placing a shaped implant over the muscle is a potential alternative to a breast lift.

Natural looking results that age with you

That said, an implant placed over the muscle will subtly descend as your breasts descend with age. This helps maintain a natural look as you get older.

Cons of Over the Muscle Placement

Implant visibility

The risk of visibility is greater when the breast implant is placed over the muscle. This is especially true for those with minimal natural breast tissue, or very low body weight.  This can also include a more dramatic or visible “step-off’ at the upper pole of the implant since the muscle does not smooth the transition.

Rippling, wrinkling and folding

Increased risk of visibility also means increased risk of seeing rippling, wrinkling, or folding, especially near the top of the implant where natural tissue is thinnest.

Capsular Contracture

Capsular contracture is an immune system response in which the body reacts to the implant as a foreign object and surrounds it with scar tissue to isolate it from the rest of the body. It’s not known why some develop this condition and others don’t, but it’s more common in over the muscle implants.

Bottoming Out

Bottoming out is a rare phenomenon in which the implant drops too low on the chest wall. This happens when skin elasticity is insufficient, or if the implant wasn’t properly placed during surgery. It’s far more likely to occur with implants placed over the muscle.

Mammogram Issues

While it’s possible to have a safe and effective mammogram after any type of breast implant surgery, over the muscle placement can interfere with breast tissue visibility.

Under the Muscle (submuscular) Breast Implant Placement

Placing a breast implant ‘under the muscle’ refers to submuscular placement in which the implant is placed below the pectoralis muscle. During implant insertion, the pectoralis muscles are split. This makes the breast augmentation recovery experience longer and possibly more painful.

The under the muscle method is recommended for those with little natural breast tissue, as the muscle covers the implant, creating a more natural-looking result. If your natural breasts have already sagged due to age, an under the muscle implant can look unnaturally high, in which case over the muscle placement is preferred or a breast lift (mastopexy) may be added.

Saline implants are typically placed under the muscle because they are firmer than silicone implants. The muscle wall offers protection from puncture and also reduces implant visibility.

Pros of Under the Muscle Placement

Natural looking results

Because the pectoralis muscle covers the implant, this method is preferred for women with little natural breast tissue or for those who are very thin. The muscle effectively pads the implant for a more natural-looking result.  This creates a more smooth upper pole and reduces the “step-off” that is possible (especially with higher profile implants)

Reduced risk of capsular contracture

Under the muscle implants reduce the risk of capsular contracture from nearly 18% to less than 10% in primary augmentation patients.

Reduced risk of visibility

Due to reduced implant visibility, there’s less risk of visible rippling, wrinkling, or folding when implants are placed under the muscle.

More visible mammograms

Although it’s perfectly ok to get a mammogram with any type of implant, under the muscle placement leads to less distortion and a more easily readable mammogram.

Cons of Under the Muscle Placement

Longer Recovery

Under the muscle breast implant placement requires a longer recovery period. Your breasts may also be more painful in the first few days following surgery.

Dynamic Distortion

Lateral breast movement occurs more frequently when implants are under the muscle. With dynamic distortion, breast implants move sideways as the pectoral muscle contracts. Implants may also become displaced if extreme changes to musculature create pressure on the implant.

Snoopy Deformity

Snoopy Deformity describe a situation wherein the breast tissue sags below the breast implant.  The muscle holds the implant in place while the breast can continue to sag due to lax tissues or aging.  This does not typically occur with subglandular placement because the implant sags WITH the breast.  The treatment for snoopy deformity is typically a breast lift (mastopexy).

Double bubble deformity

Double bubble deformity can occur in either subglandular or submuscular implant placement.  This typically occurs when the breast implant pushes through the natural inframammary crease of the breast causing a new crease below the natural one.  This can occur with settling of the implant or from surgical lowering of the fold to accommodate the implant selected by the patient and surgeon.  Double bubble deformity can be treated by surgically restoring the natural fold adherence to the chest wall (capsulorrhaphy) or by fat grafting procedures if the new fold position is necessary for the selected implant size.

Which Breast Implant Placement is Best for Me?

Over the Muscle Breast Implants

You are more likely to choose over the muscle breast implant placement if any of the following is true:

  • You are already a B cup or larger
  • If you are seeking more dramatic change (choosing large implants)
  • You are active and exercise your chest muscles consistently
  • You have no family history of breast cancer

Under the Muscle Breast Implants

You’re more likely to choose under the muscle implants if one or more of the following is true:

  • You wish to minimize the risk of capsular contracture, visible rippling, or visible step-off at the upper pole of the breast implant
  • You have minimal natural breast tissue
  • You’d prefer saline implants
  • You aren’t seriously involved in strength training
  • Clear, easily readable mammograms are important to you

Video Explanation: Over vs. Under Muscle Implant Placement

Of course, every situation is unique. To make the most informed decision on which breast implant placement is best for you, consult with your doctor.

Given this, the women I am most likely to recommend over the muscle placement are generally those opting for silicone breast implants and have a good amount of their own breast tissue, and in those patients with very large or strong chest muscles (ie body builders). When there is a significant amount of breast tissue, there will be adequate soft tissue coverage making the pectoralis muscle superfluous in this regard. Also, those with robust chest muscles are more likely to have significant distortion on animation and should consider subglandular placement.  Silicone implants are preferred for subglandular placement due to their more natural look and feel compared to saline implants.

In most cases, I recommend submuscular or “dual plane” placement with silicone implants. This gives a natural, long lasting result for most patients and yields the lowest complication rate. Further, it facilitates future breast lifting procedures by preserving the best blood flow to the nipple.

Additional Resources On Implant Placement

 


Cameron Craven, MD, FACS

Cameron Craven MD, FACS is board certified by the American Board of Plastic Surgery. Dr. Craven specializes in the full spectrum of cosmetic surgery including breast augmentation, liposuction and body contouring, facial rejuvenation, laser surgery, eyelid surgery, and rhinoplasty, as well as reconstructive surgery for skin cancers.


76 Responses to “Breast Implant Placement: Over vs. Under The Muscle”

  1. Avatar Susan H. says:

    I didn’t realize that a breast implant could be placed either over or under the muscle. I agree that women undergoing breast augmentation should understand the benefits and drawbacks of each technique. Like you said, it is a matter of personal preference.

  2. Avatar Nora M. says:

    So they can do those implants above or below the muscle. I hadn’t known about that, but I’m just starting to research this stuff. It sounds like the ones put under the muscle look more natural. That is more my style. I’ll have to keep looking into this before I decide, though.

  3. Avatar Emily says:

    I think that I would definitely prefer over the muscle placement. It seems like it would be a much easier surgery and have much better results. It says that one of the cons is that it will have a less natural look. I think the the pronounced roundness is what I’m looking for.

  4. Avatar becky says:

    I have 355cc silicon over’s. I have a very natural shape and they move with me. The only time you’d know I had an enhancement would be laying down as natural breast drop towards the armpits and enhanced stay in the pocket. I love how they look.

    • Avatar Michelle says:

      I see it has been a year since your breast surgery. Are you still happy with your placement of over the muscle? Have you experienced any rippling or sagging?

    • Avatar Brittany says:

      Did you have much before the implants? I’m really stuck whether to go under or over with the same size implant that you had.

    • Avatar Cherry says:

      I have over the muscle 400cc Mentor Silicone Gel Implants. I am Asymmetrical, but they feel and look natural. No one who would squeeze my breast would know I have implants. It has been about 4 years since they were implanted as time has gone on they will feel more natural if your skin needs to stretch. I have no Stretch Marks.

      Presently I am planning to get larger Mentor Silicone Gel Implants to look more appropriate for my size. I come from a family of ugly large people. Once when I was young my Great Aunt was coming to visit my Grandfather from Oklahoma. I asked what does she look like? I was told imagine Grandfather in a dress. OMG

      I am 6′ tall, but not as big boned as my Grand Parents, but I am significantly taller than my parents.

      My sister’s daughter dwarfs me. I don’t know how tall she is, but she is in a different elevation.

  5. Avatar Jane says:

    I had no idea that there are different options for breast augmentation! I guess you’ve got to decide what your priorities are–do you want a natural look, for example–in figuring out which method you’d prefer. Thanks for the informative article!

  6. Avatar Sarah says:

    hello, i am getting a boob job done in 3 weeks time and i am still undecided whether to go under or over the muscle, im having silicone 275cc, i want them to look as natural as possible, im around a 34b and with alot of breast tissue, someone help me with what i should get?!

    • WD Staff WD Staff says:

      Hi Sarah, Thank you for reading our blog and submitting your question. I’d like to start off by emphasizing how important it is to talk this over with your surgeon during your consultation. Your provider will be able to see how much natural tissue you have (and thus how natural your result will be given each placement type). You could even go for a second opinion, by getting a consultation with another surgeon in your area.

      That being said, if you have significant natural breast tissue subglandular placement might be the way to go. The more natural feel of a silicone implant also supports an over the muscle placement.

      Thanks again and enjoy your new breasts!

      –WD Staff

      • Avatar Sissy says:

        I have had my implants under the muscle for a long time. Getting ready to have them replaced due to recall. ( I know funny boob recall) I love mine under the muscle they look and feel natural. My last augmentation was 35 year’s ago.

        • Avatar Nicole says:

          Hey Sissy,
          I’m interested in how yours turned out and how your experience was. I am thinking of having my breasts redone after 22 years. I’ve had 3 kids and breastfed all 3. I initially got a C cup. Can’t remember my CC’s. I’ve gained some weight since my 20’s haha and they are now a 36DD. I also have quite a bit of discomfort in my left breast. I had mine under the muscle. I had never thought of having above the muscle. Is it an option to change? Did you have to have them lifted? Just trying to get a feel for what it’s gonna be like. I had quite a bit of pain after my first surgery and am hoping this one won’t hurt as bad. Thanks for any help and info.

  7. Avatar stella says:

    Good points on this post, thanks for sharing. I’m currently researching breast lift procedures and appreciate your help

  8. Avatar Jessica says:

    I have a question please,
    I had breast augmentation 2.5 years ago, silicone and under the muscle. They are great!
    In the last 6 months I have been working out a lot more at the gym and I’ve recently noticed only my left implant becomes slightly deformed or looks slightly different when my pectoral muscles are flexed. Is this a concern for long term? Really no one but my husband and I would ever see it, just curious if it should be a long term concern. Thank you!

    • WD Staff WD Staff says:

      Hi Jessica, thanks for reading our blog and submitting your question. I think the best thing to do would be to come in and have your implants inspected by one of our cosmetic surgeons. Are you currently in the Austin area? If you would like we can setup a complimentary visit with one of our specialists.

      If you’re interested in coming in please reply back to this comment and let us know if it’s ok to reach out to you vie email (using the address you entered while posting this comment).

      Thanks,
      WD Staff

      • Avatar Francine says:

        What about post bilateral mastectomy implants? I am currently researching options due to complications from reconstruction surgery – TE to implant in August, 2016. Right silicone implant migrated toward armpit, left has capsular contraction. Vitamin E and massage appear to be having no effect in the progression of capsular contracture 1 month since initiating the attempt. I have already flagged your clinic as an option for revision surgery, but just discovered the prepectoral option. Looking for solution most likely to reduce/eliminate future complications and surgery, and to keep my initial small C reconstruction. My initial PS was “unable to get the TE fully up under the pectoralis muscle and the e change PS did not modify the pocket. I am in Arkansas but willing to travel for better results and doctor’s with more extensive and updated techniques. I have distortion with flexing the pectoralis muscles, particularly on by side where the pocket never developed in the upper pole because the TE wasn’t up there far enough. I had no radiation or chemo! Early DCIS diagnosis, high score (70) on DCIS oncotyping, 2cm tumor removed, clean margins, 2 negative nodes and no other cancer in breast tissue found after removal. I am a UT graduate and love Austin!

        • WD Staff WD Staff says:

          Hi Francine,

          Thank you for reading our post and responding with your question!

          Typically going from subpec to prepec is not a good option. However, each case is unique and it is very complicated to give you a good answer without a physical examination.

          If you do decide to come into Austin, we would love to have you for a free consultation with Dr. Chuma Chike-Obi (https://www.westlakedermatology.com/chuma-chike-obi-md/). Dr. Chike-Obi specializes in post-mastectomy and revision procedures and I have briefed him on your question.

          I’ll also reply directly to your email in order to make sure you receive this correspondence.

          Thanks again,

          –WD Staff

        • Avatar Sharon says:

          Hi Francine I have the same post Mastectomy issues wondering what you decided and how things went.

  9. Avatar Dr. Levis says:

    Breast implants look more natural and feel comfortable when it placed below the muscle. It also does not obscure mammography (both silicone and saline implants) and also both the silicone and saline stay safer for longer if placed below the muscle.

  10. Avatar Anna says:

    Implant malposition is another complication with breast augmentation that can occur as a result of the patient’s tissue and skin quality. Thin tissue or thin skin paired with a heavy implant can stretch out the breasts and lead to “bottoming out,” which makes the nipples appear too high on the breasts. Implant malposition can be corrected by adjusting the scar tissue or strengthening it with tissue support material.

  11. Avatar Danielle says:

    Hi there. I’m looking at having my boobs enlarged. I have always been an A cup but I’ve had four kids in 4 years and I’m just left with a flat small amount of skin. I have my first app next week with my personal worker to discuss options but I would like to know your preference on what is safer, saline or silicone and is it better under the muscle or over as I think I’d prefer under but the pain aspect and recovery time worries me with four young children to look after. Also if a rupture was to happen with silicone and you didn’t notice, is it harmful/toxic/dangerous to the body? I don’t see much information about what happens if one did rupture that was silicone. Thank you

    • WD Staff WD Staff says:

      Hi Danielle, thanks for reading our blog and submitting your question!

      First, I’d like to caution that each individual woman is unique in terms of what options will work best for them. So we would encourage you to discuss these matters with your surgeon during a consultation, so they can judge the best course of treatment for your specific needs!

      Generally, it sounds like a silicone implant placed under the muscle might be the best option for you. However you are correct that going under the muscle requires a longer recovery time.

      Finally, a silicone implant rupture that goes unnoticed for a long period of time can be harmful to the body. The FDA recommends that all patients should obtain an MRI 3 years after the breast augmentation, and then every 2 years thereafter, to detect silent rupture at an early stage. So that is something else you should consider.

      Hope that helps!

      WD Staff

  12. Avatar Chris says:

    My wife is having a double mastectomy as a way to prevent cancer. She and her sister both will be doing this. Bit have the brca1 gene. My wife is 38. Her mother dird from breast cancer 16 years ago at age of 42. My wife, Stacy, has already had her ovaries and tubes removed and is experiencing some early onset menopause. She is otherwise in good health. She is a D cup and is mostly dreading the surgery. Her only ace in the hole (besides reducung ger chances of cancer from upwards of 80% to as low as 4%) is new boobs with little to no sag. Something that hasnt botgered her significantly but she has always wished theyd were a bit more firm. I think she said the plastic sugeon says over and the general surgeon doing the mastectomy says under. Each has pros and cons when put sisde to side donr make the choice any easier. What stand do you take on her pending decision. Her surgery is july 6th. Thanks.

    • WD Staff WD Staff says:

      Hi Chris, Thanks for reading our blog and submitting your comment. We are sorry to hear about your wife’s upcoming procedure but we do see patients under similar circumstances.

      I want to caution that we can’t really provide specific medical advice without seeing a patient in person. However, we can confirm that over the muscle placement often results in breasts that are fuller and more firm. So we would assume that is why the plastic surgeon you’ve seen recommended that option.

      Additionally you might want to have further discussions with the general surgeon as to why he recommend under the muscle placement. Are there any medical concerns?

      I hope the above insights help, we always caution people who comment on our blog to deeply research their options and discuss the matters in-person with board certified physicians.

      Thanks,
      WD Staff

  13. Avatar Barbara says:

    Hello, I have double lumen 28 year old implants under the muscle. I have considerable scar issue/capsule contraction. I need to have them remove. The first PS I’ve consulted with suggest taking them out & putting the silicon implants over the muscle with fat graphing to fill in at the top. From what I read in your article, above the muscle is fuller & rounder. So I’m not sure about the fat graphing. He feels going back under the muscle in the same pocket will result in capsular contraction again. I want a natural look. Any suggestions??

    • WD Staff WD Staff says:

      Hi Barbara, Thanks for reading our post and submitting your question. We appreciate you taking the time to share your story!

      Unfortunately the previous surgeon you consulted with may be right. Due to the scarring and contraction you mentioned it may be wise to shy away from using the same pocket.

      My best advice to you would be to get a second in-person consultation with a different (Board Certified) plastic surgeon. This way you can get a different opinion after being assessed in person. If you are in the Austin area, please feel free to give us a call!

      Thanks again,
      WD Staff

  14. Avatar Debbie says:

    Hi, I had a breast augmentation 31 yrs. ago. I am 63. One of my implants ruptured so I am having both implants removed and replaced. My surgeon recommended under the muscle. My concern is the extended recovery time and increased pain. I’m also concerned that they will feel less…breasty. I opted for a size larger as opposed to a lift. My doc also suggested nipple postioning. Again, I am 63 and have no plans to pole dance or go topless so no thanks to lifts and nipple positioning. I was an A cup, C cup after the augmentation. How wrong am I?

    Thank you for providing research material for me!

    • WD Staff WD Staff says:

      Hi Debbie,

      Thanks for reading this post and submitting your great question!

      First off, your concern regarding recovery time and pain with an under the placement is completely valid. All things considered, recovery from an above the muscle placement is usually shorter and less painful.

      However, in terms of a natural result, under the muscle placements can yield breasts that look and feels natural. Your surgeon might also have some other concerns regarding your current implant pocket which might lead to the recommendation of under the muscle placement.

      It might be a good idea to follow up with your surgeon directly about his recommendation and thoroughly discuss your concerns. Also it sounds like you might want to also benefit from a second opinion.

      We hope that helps!

      –WD Staff

  15. Avatar Emma-Louise says:

    Hi I’ve had over the muscle implants a year ago and have just had revision and they dropped within 2 months or the first surgery conciderably. I am now having them put under the muscle but wondered what the biggest I would be able to go is? I’m guessing no where near the size you can go over the muscle?

    • WD Staff WD Staff says:

      Hi Emma-Louse, Thanks for reading our post and submitting your great question! Generally speaking implant placement (above muscle or below muscle) does not restrict the implant size as much as many other individual characteristics inherent to each patient.

      This is a great question for your perspective surgeon, ideally discussed during an in-office evaluation. Specifically, ask your surgeon what’s the best size for your specific situation and desired end result.

      Hope that helps!

      Thanks,
      WD Staff

    • Avatar Laila says:

      Hi Emma-Louise,
      Did you find the silicone placement above the muscle or under the muscle more natural and comfortable? Did you experience any rippling under the muscle? Do you experience any pain or distortion of the silicone when the muscle is flexed? What was your original cup size?

  16. Avatar Barb says:

    I am a breast cancer survivor. Initial implants were done 7 yrs ago. My right breast started shifting up and under my armpit somewhat. Just had surgery 2 weeks ago to correct. The Dr. said I have whats called a “Window Shade” of the pectoral muscle. He did what he could but it is very high and he said would probably not come down much. He had recommended to do an over the muscle implant. Or another procedure that forgoes implants all together and uses my abdomen fat to fill my breasts. Any thoughts on either one of these procedures? I know the recovery time for the abdomen fill is quite a long time, and is a major surgery.

    • WD Staff WD Staff says:

      Hi Barb, I’m sorry to hear about the issue. An above muscle placement may be a good fit given the characteristics you describe. However, its impossible to give you good direction without an in-person consultation.

      It sounds like it might be worthwhile for you to get a second opinion from a different physician. Just to see what alternatives may be possible. If you are in the Austin area, please give us a call to set up a consultation.

      Thanks,
      WD Staff

  17. Avatar Tam says:

    I had under the muscle silicon implants done in 1982. In 1998 one ruptured in a car accident and had to be replaced. Since they both had a fair amount of constriction I opted to have both replaced. The surgeon felt saline over the muscle was the best option. I am thin (was a AA cup) now a C. I have never really liked the look or feel of the saline implants. My issue is now they are both quite constricted very round and firm and need to be replaced….again. I am 62 and don’t look forward to another surgery. The longer recovery of under the muscle is a definite drawback and is it even possible since I’ve had it before. Too much scar tissue? However having very little breast tissue to cover implant is an issue. Any comments?

    • WD Staff WD Staff says:

      Hi Tam,

      Thanks for reading our post and submitting your comment. I’m sorry to hear about your accident and need to undergo revision (yet again).

      It sounds like the best option will depend on the current characteristics of the implant pockets, you’ll definitely have to see an experienced surgeon for an in-person consultation. In some instances, excess scar tissue from previous surgeries can limit implant placement options.

      If you are in the Austin area we would love to setup a free consultation. Please give us a call if you would like to see one of our specialists.

      Thanks,
      WD Staff

  18. Avatar Ev says:

    I was wondering what you thought about fat transfer to the breast. I have thin skin and am interested in breast enhancement.

  19. WD Staff WD Staff says:

    Hi Ev, thanks for reading our post and submitting your question. Doing a fat transfer augmentation may be a good option! However, you should get an in-person consultation with a board certified plastic surgeon so they can make sure its a good fit (given both your body’s natural characteristics and your desired end result).

    Please feel free to give us a call if you are in the Austin area and would like a consultation!

    Thanks,
    WD Staff

  20. Avatar Brittany says:

    I had a lollipop lift and 450cc silicone moderate profile put under the muscle. Im 5 months post op and neither my surgeon or I are happy with the results. Im glad he sees what I see. The lift wasnt aggressive enough and hes dealing with a lot of constriction in my breast shape. Im not a petite woman but we are considering high profile during my next surgery to help with the constriction issue as the implants seem larger than my breast pocket is allowing. But Ive also read some articles that state over the muscle may be better for breast loft candidates for that upper pole fullness.

    What are your thoughts on breastlift + implant and implant placement. I never considered over the muscle so I will being this up to him our next visit.

    • Avatar Brittany says:

      Also I will add that he will be doing some significant pocket work as my implants seem to fall to the side and have started to bottom out. I deal with thyroid issues and have read that can lead to slower internal healing, so maybe my pockets didnt form like they should have?

    • WD Staff WD Staff says:

      Hi Brittany, thanks for reading our post and submitting your excellent comments! Over the muscle placement may be beneficial, however there are many characteristics that must be considered. I think its a wise idea to bring this up with your surgeon during the in-office consultation.

      Thanks again,
      WD Staff

  21. Avatar Melody says:

    Hello
    I will be having a consult in a couple weeks for breast augmentation. My breast size has changed a lot over the years. I have some breast tissue now, but more skin than anything. I was originally A, then a large C while nursing. Now back to A/B. I do not want large breasts, no more than a full C. I want to look natural.
    I am very active and lift weights. Will having implants put under the muscle keep me from lifting in the future? I am concerned about damaging something as my muscle mass changes with lifting. Also, what is the normal recovery time for under the muscle? Thank you so much for reading!

    • WD Staff WD Staff says:

      Hi Melody,

      Thanks for reading our post and submitting your question! As always, we would recommend you to see a board certified plastic surgeon for a consultation. But generally speaking, it sounds like an under-the-muscle implant may be a great option for you. Specifically under muscle placements may actually provide some durability benefits (i.e. the implant is better protected) for women who lift weights. However, as you stated the recovery is longer than an over-the-muscle placement.

      I hope that helps!

      Thanks,
      WD Staff

  22. Avatar Leanna says:

    Hello,
    I am getting a breast enlargement.

    He has suggested under the muscle I am 5.2 8stone and 32b I want to be a d/dd I want them natural but not saggy will the weight of the implant make them saggy?

    Thank you.

    • WD Staff WD Staff says:

      Hi Leanna,

      Thanks for reading our post and for submitting your great question! I think the only way to really give you a good answer would be to have you come in for an in-person consultation (second opinion). If you are in the Austin area, please give us a call!

      Thanks,
      WD Staff

  23. Avatar Sally2 says:

    Im looking to get breast implants. Very confused weather to get under the muscle or over . I’ve lots of breast skin as my weight fluctuates between 8 stone and 9 pretty much all.the time so.i feel there is excess skin. So do i go over or under and I want them.to.look as natural.as possible also but still much perkier than what I have now they are not perky at all. Help

    • WD Staff WD Staff says:

      Hi Sally,

      Thanks for reading our post and submitting your great question! First off, you’ll need to get an in-person consultation with a Board Certified Plastic Surgeon. An assessment by an experienced professional will be the only way to receive the best treatment plan given your unique characteristics and needs.

      With that disclosure out of the way, it sounds like you should ask your surgeon about an under-the-muscle placement. It may provide the naturalness you are seeking!

      Thanks,
      WD Staff

  24. […] asked him to “fill them back up” LOL!).   He inserted the implant under my muscle.  “Under The Muscle Placement (sub-muscular placement) Sub-muscular placement is a technique in which breast implants are placed partially […]

  25. Avatar Charisse says:

    Hi ! I found this website through google . I just have a quick question regarding my implant ? I had and accident last weekend . I fell down the bed and hit my right breast on the edge of the bed . Now i feel so bad pain . On my arm pit . On top of my breast . When i cough i feel the pain too . The muscle is so pain right now . I wish and hoping you will answer my questions . I really appreciate it . I don’t know what to do now !

    • WD Staff WD Staff says:

      Hi Charisse,

      Sorry to hear about that! Implants are typically able to withstand great amounts of trauma. That being said, if you are still experiencing pain you may need to see a professional for an assessment. Your best bet would be to visit the surgeon who did your procedure. Most will provide a free consultation/visit since they performed the initial surgery.

      I hope that helps and you feel better!

      Thanks,
      WD Staff

  26. Avatar Laila says:

    Hello,
    I had a breast lift and enlargement last year. The silicone 225 cc was placed above the muscle, my breast tissue wasn’t much (small B) and I had a lot of skin after breast feeding and several weight fluctuations. Post operation I experienced sagging, so I had another operation last month for lifting them up again. On the right side there is obvious rippling and I can feel the edges of the silicone with my hands, it doesn’t feel natural at all. My surgeon says that behind the muscle works more for flat women, but as I already had breast tissue and wasn’t flat, I could experience a case called ‘double bubble’ where the breast tissue could drop down while the implant stays in its place. Besides he said behind the muscle weakens the muscle please advice

    • WD Staff WD Staff says:

      Hi Laila, Thanks for reading our post and submitting your comment. Your surgeon may be correct, however it is impossible to say without assessing you in person. In fact, we would suggest getting a second opinion from a different board certified plastic surgeon if you feel that your current surgeon’s assessment is incorrect. If you are in the Austin area, please give us a call at 512.328.3376 to setup a consultation.

      I hope that helps!

      Thanks,
      WD Staff

  27. Avatar Honey says:

    . I went to four different doctors for consults and 2 said under 1 said over and the other one said I could do either over or under. The doctor say I have plenty of tissue for over.. I workout a lot and I want to know what is better? I am worried if I go under the muscle that I won’t be able to workout as much. Doing push-up pull-up burpee and some weight training.. then I worry if I go over I won’t be as protected. I am getting silicone high-performance gummy bear implants.. please help

    • WD Staff WD Staff says:

      Hi Honey, thanks for reading our post and submitting your question. Unfortunately we can’t really provide a specific opinion without seeing you for an in-office assessment. Your concern regarding placement of the implant and restrictions on physical activity (especially weight training) are justified. In some instances over the muscle placement may be preferred. However it really depends on several characteristics of the breast.

      Are you in the Austin area? If so please feel free to give us a call to setup a free consultation. Our surgeons would b able to provide a more in depth treatment plan after seeing you in person.

      Thanks,
      WD Staff

  28. Avatar Mars says:

    Im getting my breast done 470cc but im concerned either to go under or over muscle . Please help. Im a 36c but my opinion more like a 36b.. please help me.
    Decision….

    • WD Staff WD Staff says:

      Hi Mars,

      Thanks for reading our post and for submitting your excellent question. Unfortunately we are not able to provide specific recommendations without assessing you in person during an in-office consultation. If you live in the Austin area, please call us today to setup a consultation.

      Otherwise we suggest discussing this issue with your current surgeon. If you feel uncomfortable with their assessment, we always recommend getting a second opinion!

      Thanks,
      WD Staff

  29. Avatar Matilda says:

    Good day, i am from SA and would like to know if you can help. I had implants 7years ago in front of the muscle and they feel like they are sagged. my one breast was bigger then the other before the opp and still looks like that. i literally want them round. what is the best to do?

    • WD Staff WD Staff says:

      Hi Matilda,

      Thanks for reading our post and submitting your excellent question. Unfortunately it is very hard to help without seeing you in person for a consultation. However, we would recommend you seeing a surgeon about this issue. It’s possible that your implants have been damaged or malpositioned.

      Alternatively you can look into finding a new surgeon that specializes in breast implant revision procedures (see this blog post for more info: https://www.westlakedermatology.com/blog/breast-implant-revision-case-studies/).

      There are definitely ways to help your situation, a qualified surgeon will be able to assess your needs in person and advise you on solutions.

      I hope that helps!

      Thanks,
      WD Staff

  30. Avatar Taylor says:

    It’s interesting that more cleavage can be created when a breast implant is placed over the muscle. My friend is very flat-chested, so she’s been thinking of getting breast implants like her mother did. I’ll share this article with her, so she can decide with type of breast augmentation procedure is best for her.

  31. Avatar Alicia says:

    Hi.i just had gel cohesive gummy bear 485cc implants under the muscle put in recently through my armpits..like very recently ( 10 days ago) I am finally just able to get up n move around on my own so my first comment is buyer be ware for healing time and pain levels for submuscular implants.
    Secondly, they dont look as large or round as I’d like. Every1 keeps telling me theyll look great to give it time..I just fear they say this because they dont want me upset..should I have gone above the muscle for a fuller look??

    • WD Staff WD Staff says:

      Hi Alicia,

      Thanks for submitting your comment and reading our post. We’re very sorry to hear about how long your recovery took. The experience definitely differs by patient and unfortunately submuscular placement does involve a longer recovery time compared to above muscle placement.

      In terms of that appearance issue, it’s definitely hard to assess without seeing you in person. It is true that it can take some time for the implants to fully “settle”. It will be a few weeks before the final result of the procedure is achieved. But if you already have concerns we would encourage you to contact your surgeon. You may even want to schedule an in-person appointment so they can asses the healing and counsel you on those concerns.

      We hop that helps!

      Thanks,
      WD Staff

  32. Avatar Rayne says:

    Will placing the implants above the muscle increase your chances of losing feeling in the nipples?

    • WD Staff WD Staff says:

      Hi Rayne,

      Thanks for your great question! It is true that above muscle placement (subglandular placement) can increase the risk of sensation loss as such placement is more likely to impact the nerves. However, it is still possible for sensation loss to still occur even with under the muscle placement (submuscular placement). Also there are other ways to minimize the chances of sensation loss like choosing an experienced board certified surgeon and making sure to choose implants that are not too large for your body frame.

      In general, we would encourage you to raise this question during your consultation with a highly qualified surgeon. They’ll be able to assess your specific characteristics and warn you about choices that could increase the risk.

      We hope that helps!

      Thanks,
      WD Staff

  33. Avatar Rula says:

    hi Dears,

    I am getting a breast implant called MOTIVA . And i am a size 34b or 32C ,, my surgeon suggested to go over the muscle . but i am scared it will not look so natural since i want to go up to D size . What do yo suggest ? do you think i should go under the muscle ?

    one more concern is about breast cancer , is it possible to check breast cancer tumors when having an implant over or under the muscle ? because my granma had breastcancer . And i am doing the check ups yearly .

    Regards,

    • WD Staff WD Staff says:

      Hi Rula,

      Thanks for reading our post and for submitting your great questions! In terms of the placement question, we would not be in position to give any good advice without assessing you in person. You may want to get a second opinion (in-person assessment) with a different (board certified) surgeon if you have any concern with your current surgeon’s suggestion. It’s a great way to make sure you are getting the best advice. You don’t even have to disclose the second opinion to your current surgeon if you don’t want to.

      For your second question, cancer screening is still possible with an over the muscle placement. They are, however, a bit tricky and require additional views. Here’s a good resource on that https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/mammograms-for-women-with-breast-implants.html. This is another case where talking with your current screener may be beneficial. Since you’re already getting images taken they should be able to assess the added difficulty that an over the muscle placement can cause.

      Sorry we could not be more helpful but we hope you follow up on the above to get some clarity before undergoing the procedure.

      Thanks again,
      WD Staff

  34. Avatar Aoife says:

    Hey went for second consultation today I am currently size A cup looking to get 240cc I assumed would be going under the muscle but I have bone inbetween my boobs so the surgeon said over would be better to get them closer I’m unsure will they look more fake going over?

    • WD Staff WD Staff says:

      Hi Aoife,

      Thanks for submitting your comment to help our community! It’s hard to give direction without seeing you in office for a consultation. Right off the bat we’d probably recommend getting a second opinion from a different surgeon. It may be a good idea to get a second perspective from a different board certified surgeon. You can zero in on their suggestion in terms of placement. If they suggest going under, advise them about this surgeon who recommended an over the muscle placement due to your anatomy and ask why he/she is wrong.

      Also make sure to ask any surgeon for before/after photos of a similar case (someone with your build with implants of around 240cc).

      We hope that helps!

      Thanks,
      WD Staff

  35. Avatar Dr. Jaibaji says:

    Great point on reducing the risk of rippling visibly if you have your augmentation under the muscle. I’ve seen this in my experience as well.

  36. Avatar Alisha says:

    I really want a more natural look but I don’t have much natural tissue. Sounds like above muscle is not the way to go. Thanks for all the help

  37. Avatar Julie says:

    I had implants placed over the muscle for my first breast surgery 13 years ago. For the most part, I really liked how I looked. I had nice full-looking breasts and nice projection in clothes. As I aged and the skin and tissue over my chest thinned, I had to be careful about the breasts being “pushed up,” because I would end up with a visible edge of breast implant up top (which was not desirable, but was easy enough to work around. Over time, I developed significant capsular contracture on both sides— but especially on my left side. The breasts still looked good in clothes, but without clothes they looked really weird— like two high, tight balls on my chest wide apart from each other, with the tissue around them distorted and my nipples pointing down. Not a good look.

    I got a breast revision 6 months ago to remove the capsules and scar tissue and replace the implants. My implants are now a different size and profile and placed under the muscle. I absolutely hate the way my breasts look now. In spite of my very detailed explanation of the look I wanted (and the looks I did NOT want) at 2 consultations prior to choosing him as a surgeon, plus a pre-surgical consultation and one last chat the morning of surgery, as well as his assurances all along that we were on the same page and he could do exactly what I was asking…the surgeon ignored my desired aesthetic and did something completely different than what we discussed! In our consultations, I had even pointed out breasts that looked like the breasts he ended up giving me, as examples of what I absolutely did not want! Anyway— by no means am I blaming this unsatisfactory (frankly, devastating!) outcome on the submuscular placement of the implants alone. But that is a facet of my unhappiness. I had no idea how much implants under the muscle would “jump” up and out towards the sides of my body EVERY time I do ANY movement that involves my pectoral muscles. It looks so gross! And it’s come as a shock to me, since I’d heard over and over again that submuscular placement “looks much more natural.” In my case, I wholeheartedly disagree. When it comes to moving about with normal daily activities, including working out or wearing a lower cut shirt with a standard bra, above the muscle absolutely looked better. I’m mortified after seeing what the breasts of women who work out look like after a few years when they’ve had submuscular placement of implants. I also can’t stand the shape of my breasts now. Very little projection, no roundness (too much roundness looks bad, IMO, but SOME roundness is nice), a rather “squished” appearance. It’s hard to explain, but I feel anything but sexy. I won’t even let my husband see my breasts. And recovery was WAY worse than with my first surgery— even though that surgery was much more difficult and took 8 hours! (The doctor was trying to repair my tuberous breasts, which is very complex.) The recovery for this surgery was much more difficult. I wound up in the ER on the third day because I was in so much pain and could not keep any food or meds down. They had told me I would only need to keep the drains in for 5-7 days…I ended up needing them in for 2 weeks (the one on the right was STILL draining more than they had originally said it should be draining when they took it out). I had pain any time I bent forward forward for 4 months. And it took much longer for the implants to “drop and fluff.” As I’ve now found out, results are actually less predictably when the implant is placed under the muscle.

    If I had to do this over again, I would go with a gummy bear implant, or a moderate or moderate plus implant over the muscle, with fat grafting to conceal the edges of the implant/make sure there was a natural looking slope.

    Be careful!!!!!!!

    My bad outcome is compounded by the fact that I cannot get a revision any time soon, as my husband and I want two kids and I am nearing the end of my fertile years. The plan was to get surgery to remove the capsular contractures/old implants so I wasn’t going into pregnancy with that discomfort, wait 6 months to heal, then start trying for a baby. To have a revision now would mean I would need to wait a minimum of 4-6 months before trying to get pregnant, according to one of the surgeons with whom I consulted (and he warned me that he was concerned I could still have complications like mastitis), and longer than that according to the surgeon who botched my first surgery (who said “You’re not a candidate for a revision until after you finish having children, period.”).

    If I had to do this again, I would pin the surgeon down and make him share the details of what he was going to do to achieve the look I wanted. He wouldn’t commit to the type of placement he was going to do or the size of implant he was going to use— and in hindsight, it was insane of me not to make sure we had made that decision together prior to the surgery. I tried to pin him down on size and placement, and he said, “I know exactly what you want, you don’t need to worry about those details. I’ll have many implants on hand and will pick the best size and profile and placement during the surgery.” Anyone reading this who is considering any kind of plastic surgery needs to know that a nebulous response like that is a HUGE red flag that can easily lead to a plastic surgeon leaning towards their own aesthetic instead of YOUR aesthetic when it comes to crucial components of surgery, such that you end up *hating* your results. It’s one thing for a surgeon to say, “I’m planning on doing A, but if obstacle x, y, or z comes up, I will then do B.” That’s a plan you can follow. And if there’s something you don’t like about it, you and the surgeon can discuss alternatives. But a surgeon who says they’ll give you exactly what you want, yet cannot explain the details of HOW they’re going to give you what they want, is probably full of shit and has only told you they can give you what you want to get your business. And the kicker is, plastic surgeons KNOW that there is little recourse for a patient whose surgery was performed competently (as in, no issues with nerve damage or necrosis or significant deformities) but is unsatisfactory from a cosmetic perspective. A seasoned surgeon who has a great reputation and lots of business is unlikely to do this. But in my case, this was a young surgeon who is charging WAY more money than the other plastic surgeons with whom I consulted, who performs surgery in an OR that is part of his office (so that he doesn’t even have to pay hospital OR fees)

  38. Avatar Felice says:

    Go under the muscle! Unless you don’t have enough tissue, under the muscle just looks more natural. I’ve compared friends boobs and I’m telling you under is better

  39. Amazing Blog! It is more valuable information for all.

    Thanks!

  40. Avatar Greta says:

    Big decision, my surgeon pushed for above the muscle but I decided to go under. I’m very happy I did, love the results

  41. Avatar Melisa says:

    I have my pre op appointment at the end of this month for a breast augmentation. I’m currently a lg A to small B cup. At my consultation I went with 530cc but after leaving I called the office cause I wanted to go bigger. I told them that I was thinking about 800cc. The doctor said he prefers to do only under the muscle which is fine but would 800cc be too big for under the muscle? I’m wanting to have a fuller natural look as well.

    • WD Staff WD Staff says:

      Hi Melisa,

      Thanks for reading our post and sharing with our community.

      Without assessing you in-person it would be very difficult to know if 800cc would be too big for a natural result. It depends upon the characteristics of your chest/body. You may want to request a re-evaluation at 800cc to see if your surgeon still feels the result will look natural.

      We hope that helps!

      Thanks,
      WD Staff

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