Which is Better? Under Muscle vs Over Muscle Implants

Breast augmentation is the #1 cosmetic surgery procedure in the world. It has among the highest patient satisfaction ratings of any cosmetic surgery. If you have been thinking of getting breast implant surgery, there are some decisions you will have to make. One of the most important decisions is choosing under or over the muscle breast implants.

I’m guessing you found this page because you saw a great price online for breast implant surgery and got very excited. Perhaps you even went to consultation, only to learn that the surgeon only offers above the muscle breast implants. That got you thinking…Are under muscle or over muscle implants better for me?

In this blog post, Dr. Bernard Beldholm, FRACS, discusses the pros and cons of above vs below the muscle implants. Aesthetics, safety, and practical concerns will be addressed. You’ll also learn about the dual-plane method, which provides the “best of both worlds”. When you reach the end of this article, you will have a better understanding of which method will look best on you.

If you’re torn deciding if over or under the muscle breast implants will give you a better result, keep reading.

Your natural breast tissue plays a role in the decision

Generally, above the muscle implants have a more natural-looking result for a variety of reasons. However, most of Doctor Bernard’s patients don’t have enough breast tissue coverage on the upper part of the breast to make above the muscle implants look good.

As a body contouring surgeon, a lot of our patients are post-pregnancy or post-weight loss. They tend to have loss of fullness in the upper breast. Usually, there is a very thin layer of breast tissue. For these patients, placing the implant above the muscle means the implant would be visible. This is not an attractive look.

Other patients seeking breast augmentation may have little breast tissue coverage to begin with. Without the extra breast tissue to cover the implant, the implants will be visible if they are placed above the muscle. It is best to get under muscle implants if you have very little natural breast tissue or upper pole fullness.

The main reason for placing breast implants under the muscle is to get extra padding on top of the implant so it doesn’t look obvious that you got breast implants.


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Pros and cons of over the muscle implants

For some patients, over muscle breast augmentation is the right choice.

Benefits of over the muscle implants

Above muscle implants can look more natural, but only on patients that have enough natural breast tissue to cover the implant. Otherwise, under the muscle or dual-plane breast augmentation is recommended.

Above muscle implants appear more natural on the right candidates for several reasons. Placing implants above the muscle helps prevent a common unwanted side effect called the double fold. That is when your natural breast fold cannot stretch to accommodate the implant, causing a cosmetic defect. A double fold is much less likely to happen with above muscle implants.

Additionally, placing the implant above the muscle means you don’t have to worry about visible muscle bands when you work out or move your arms. This can happen with under muscle implants as the muscle contracts the implant when you flex.

Another benefit of over the muscle implants is an easier recovery. There is less surgical dissection since the muscle is not involved. The implants are simply placed above the muscle, without having to cut the muscle at all.

Sometimes, (but not always), over the muscle implants are cheaper. Over muscle implants are a simpler surgery to perform. Since it does not require cutting the muscle, it reduces the length of time the surgeon spends in the operating room. Typically, when you see cheap breast implant surgery in Australia, they are usually doing breast augmentation over the muscle, regardless of whether this is the right choice for the patient.

That is not to say that over muscle implants are bad. As mentioned, it can produce a great-looking, very natural result on patients with enough natural breast tissue to cover the implant.

Cons of over the muscle implants

Cheaper is not always a good thing! Over the muscle breast implants are rarely suitable for patients that lack adequate upper breast fullness. A qualified cosmetic surgeon will be more concerned with making sure you have a natural, great-looking result and will not push you to choose over the muscle implants if they are not suitable for your body type.

While there is nothing inherently wrong with over the muscle implants, they are only a good choice for patients with ample upper breast tissue to cover the implant. In reality, many patients seek breast implants because they do not have much breast tissue of their own, particularly in the upper breast.

Thin patients and those lacking upper pole breast tissue are more likely to be able to feel the edge of the implant.  Worse than being able to feel the implant is being able to see the outline of the implant itself. This poses a real problem for patients that want  natural-looking breast implants.

That’s why under the muscle implants are often the better choice in many cases.

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Pros and cons of under the muscle implants

For many patients, under muscle breast augmentation is the appropriate choice.

Benefits of under the muscle implants

If you have empty breasts after major weight loss or pregnancy, or if you have very little natural breast tissue to begin with, under muscle implants look best.

In below muscle breast augmentation, the implant is at least partially covered by the pectoralis muscle. By placing the implants under the muscle, it provides extra padding on the implant so that it isn’t visible through the skin. Under muscle placement can also reduce implant rippling.

The pectoralis muscle thickness varies from person to person. On average, the pectoralis muscle is about .035 cm to .6 cm thick (or about .01 to .25” inches). Research shows that young patients and women with larger breasts often have a thicker pectoralis muscle. Muscle coverage above the implant reduces implant visibility so breasts that lack upper pole volume can get an attractive result.

Doing so makes it less obvious that the patient had “work” done, which is always Doctor Bernard’s goal. That is assuming you choose an implant size that is the suitable for your frame.

Together, you and Dr. Bernard will select an implant size that is appropriate for your body type and cosmetic goals.

Note that very thin patients and women with little to no upper pole breast fullness may be able to feel the edge of the breast implant slightly. This is normal, and there is really no way to avoid it. However, when implants are placed under the muscle, on the lower outside edge of the implant is palpable with dual-plane breast augmentation. More details on the dual-plane breast implant surgery follows below.

Finally, there is the matter of capsular contracture. According to Dr. Beldholm’s research, there is a slightly lower risk of capsular contracture from breast implants placed under the muscle. Capsular contracture is when the capsule that forms around the breast implant tightens over time. This causes the implant to look distorted and may cause pain.

All surgery has potential risks, cosmetic surgery included. There is not enough concrete evidence to say whether over the muscle or under the muscle implants are safer. However, approved breast implant devices are deemed safe by both the FDA and TGA for breast enhancement.

Regardless of your choice of surgical plane, you are in good hands when you see a FRACS specialist cosmetic surgeon. No matter which you choose, you are most likely going to be thrilled after breast enhancement.  It is one of the most popular procedures in the world for a reason. Millions of women have received breast implants around the world.

Cons of under the muscle implants

You won’t have as much cleavage with under muscle implants. The pectoralis muscle is attached to the sternum. When placed under the muscle, the pec muscle prevents the implant from being pushed up, such as when the patient wears a push-up bra. Thus, patients usually can’t achieve as much cleavage as women that choose above muscle implants.

Still, round implants give nice upper pole fullness. That helps give a bit of a “push-up” effect. It’s also nice that the muscle adds coverage in patients that lack upper breast fullness because it prevents the breasts from looking “fake”. To lower the chance of getting a “fake” looking result, you must choose the correct implant size (one that is not too big for your frame or natural breast tissue) and sometimes go below the muscle.

The other thing that happens is that the muscle pushes the implant to the side, so you have more risk of the implant moving to the side with under muscle implants.

Another thing to consider with under muscle implants is tha you may see the muscle contracting on the implant when you work out or flex your pecs, such as when you are moving your arms or lifting a heavy object. When the muscle contracts, it pushes the implant, which can result in visible muscle bands. This is not particularly obvious in most patients, and it is not harmful, but it is worth mentioning.

Finally, while implants can withstand a lot of force, having the extra muscle coverage on top of the implant may plausibly reduce the chance of breast implant rupture caused by accident or injury. Think of it like cushioning to protect your new assets.

What is dual plane breast augmentation?

Doctor Bernard generally recommends dual-plane breast augmentation to his patients. In dual-plane dissection, the implant is placed below the muscle, resting on top of the rib cage. Dual-plane means that the implant doesn’t get covered with the muscle completely. The lower part/bottom outside edge of the implant is not hiding beneath the muscle.

Earlier, we talked about how above muscle implants help prevent a double fold. A double fold can also be avoided with dual plane dissection. The surgeon creates a plane above the muscle and under the muscle to release the skin from the underlying tissues. This can prevent a double fold. It also helps to round out of the lower part of the breast so it looks very natural.

A dual-plane breast augmentation is a more complicated surgery than simply placing implants above or below the muscle. Choosing an experienced Australian cosmetic surgeon like Dr. Bernard Beldholm, FRACS that regularly performs dual-plane implant surgery helps you get the best result.

Conclusion

Your natural breast tissue dictates whether breast implants look better over the muscle vs under the muscle. Many times, patients seeking breast enhancement complain of having not enough upper breast fullness, which is a big reason that under the muscle implants are the more common procedure.

Breast augmentation is not a ‘one size fits all surgery’. During the consultation, Doctor Bernard will ask what you are hoping to accomplish with breast implant surgery. He will examine the breast tissue to help you decide which surgical approach will yield the best result.

At the end of the day, this is your body we are talking about. It is your decision when it comes to choosing a qualified surgeon that you feel comfortable with. Together, you should work with your surgeon to create a surgical plan that makes sense for your aesthetic goals. Either way, looking forward to new breasts is very exciting!