Breast Implant Placement: Above or Below the Muscle?  

What’s the Difference?

Advantages of Under the Muscle

Advantages of Above the Muscle

Most Common: Under the Muscle

Why You Should Have Breast Implants Under the Muscle

Why You Should Have Breast Implants Above the Muscle

What’s Best For You?

What’s the Difference?

For your breast augmentation, breast implants are placed above or below the pectoralis muscle. The pectoralis muscle is the chest muscle that starts in your shoulder area and fans out down towards the bottom of your breast. I have to place the breast implant around the pectoralis, and determine whether to place it above or below the muscle.

Advantages of Under the Muscle

The biggest advantage of placing breast implants under the muscle is that more tissue –  skin, breast tissue, and muscle – will cover your breast implant, resulting in a more natural look and feel with a lower chance of feeling or seeing the edge of your breast implant.  

Most patient who are “normal exercisers” – who do not lift weights 4-6 times per week –  are candidates for under muscle placement.

When done properly, the breast implants will not move very much or at all in an artificial manner if the pectoralis muscle is released at the breast fold base. Some plastic surgeons and patients feel that under the muscle placement will result in artificial movement of the breast implants when the pectoralis muscles are activated. This is simply not the case, in my opinion.  

Advantages of Above the Muscle

The advantage of placing the implants above the muscle is that there is no risk of breast implant movement when you flex or activate the pectoralis muscle. However, some disadvantages are that you may feel and see the edge of the breast implant and experience rippling and wrinkling, especially in thinner patients.  

Even if there is no rippling and wrinkling, a sharp border of the breast implant can be seen in thinner patients, which will probably not occur with implants placed under the muscle. The only way to correct this is to redo the breast augmentation and place them under the muscle, or do some fat grafting and carefully place fat all along the edges of the breast border.  

Most Common: Under the Muscle

The most common placement of breast implants in breast augmentation is to place them under the muscle.  With proper “dual plane” placement and release of the pectoralis muscle at the breast fold base, there is usually plenty of tissue coverage with a natural look and feel, and no excess movement when you flex or activate your pectoralis muscle.  

Why You Should Have Breast Implants Under the Muscle

There is no hard factual reason to have breast implants placed under the muscle, but it is the strong preference among most patients and most plastic surgeons.  

Why You Should Have Breast Implants Above the Muscle

If you lift weights often or you are a bodybuilder, then I would recommend a breast augmentation with breast implants above the muscle.  Since you are lifting heavy weights frequently, your breast implants are in danger of very early failure, because your pectoralis muscles are consistently compressing the breast implants.  

What’s Best For You?

In the end, what’s right for you depends on your body, how much breast tissue you have now, how much body fat you have over your breasts and chest, how active you are and what kinds of sports activities you enjoy, among other factors.

The best choice should be obvious after talking to your plastic surgeon!

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