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The Ups, Downs, Over and Unders of Breast Implants

According to the American Society of Plastic Surgeons breast augmentations were in the top 5 cosmetic surgeries performed in 2020. With its popularity comes an increase in information and knowledge that potential patients must consider. After determining what size, shape, and type of fill they want for breast implants, implantees are left to consider where they want them positioned.

Over the Muscle or Under the Muscle?

For the hundreds of thousands of women who elect to have this cosmetic procedure, it is important to decide which style of augmentation is best for them. Both saline and silicone implants can be placed above the muscle or below it. There is no final answer as to which is better. The choice depends on each individual’s lifestyle, goals, taste, and body composition.

How Do You Determine Which Placement is Better?

For most it is a lack of information that leads to confusion. Implants labeled as “over” are those with placement on top of the chest muscle and below the breast tissue, also referred to as sub-glandular placement. In contrast, sub-muscular implants are placed below both the breast tissue and the pectoralis major chest muscle and referred to as “under.” To determine which is better, patients need to consider the impact each procedure has.

Implant Position
What Impact Do Over and Under Have?

Over the muscle implants can look natural if they are the right shape and size. If a woman already has a B cup or larger there is usually enough breast tissue to cover the implant. The recovery time of over the muscle is shorter than under. In most cases the initial discomfort only lasts about four days.

Under the muscle implants require more manipulation of the body, and result in a slightly longer recovery. The initial discomfort lasts about ten days. Implants placed under the muscle tend to look more natural because they are covered with more of the patient’s own tissue. Implants placed under the muscle follow its natural shape and slope from the clavicle to the breast. If a patient’s breasts are smaller, the under the muscle placement maximizes the opportunity to cover the implant with tissue.

Total recovery for both types of breast augmentation procedures is similar, lasting about three months.

Related: The Pros and Cons of Gummy Bear Implants

Breast /Implants: Over Vs. Under Cost

Costs for the procedure vary and range from $5,000 to $9,500. Due to the slightly more extensive procedure, costs associated with under the muscle implantation are generally higher.
Are There Specific Recommendations?

Although there is no one size fits all recommendation, there are some limitations and factors that determine which type of procedure is best.

If patients choose a saline implant over a silicone one, an under the muscle implant is generally recommended. This is because the saline is firmer and the overlaying muscle will make it appear softer.

Patients who live an active lifestyle, such as bodybuilders and heavy weight lifters tend to benefit from over the muscle augmentation because it allows them to flex without the implant moving unnaturally. When the body is extremely lean, the muscle pulls tight over the implant and can look unnatural.

What Are the Next Steps?

If you are considering breast augmentation surgery, it’s in your best interest to find a doctor who has the proper skill and expertise. At the Royal Centre of Plastic Surgery, we can answer detailed questions based on each individual’s wants and needs; the body type, desired appearance, recovery time, budget, personal preference and lifestyle of each person will determine whether the breast implants will be better over or under the muscle.

Schedule a personal consultation with board-certified plastic surgeon Dr. Kenneth Dickie, or call us at 1-855-726-2800 to learn more.