One of the most common questions I hear in consultation is: “Can I look natural if my breast implants are placed above the muscle?” Short answer: Absolutely. You can look natural. You can look subtle and sexy. The real key is aligning several factors, such as the correct breast implant, the right placement, your anatomy, and your aesthetic goals.
Our goal at Austin Plastic Surgeon is to guide our patients to choose the option that gives them the best long-term shape, the most natural movement, and the smoothest recovery for their body, and help them achieve their aesthetic goals.
Contents
- 1 Why Were Implants Traditionally Placed Under the Muscle?
- 2 The Modernization of Breast Enhancement Happened with the Development of the Highly Cohesive Gel Implants—Gummy Bear Breast Implants.
- 3 What’s the Advantage of Above-the-Muscle Placement?
- 4 Will It Look Natural Above the Muscle?
- 5 “Above the Muscle” Refers to Several Options, Including Preservation Breast Procedures
- 6 Do Patients Still have Implants placed Under the Muscle?
- 7 Patients Have Choices and the Ability to Customize Their Breast Enhancement Procedures
Why Were Implants Traditionally Placed Under the Muscle?
If we take a step back, there’s a reason “under the muscle” became so popular in the United States.
From the early 1990s into the mid-2000s, silicone gel implants were taken off the market, only used for patients who were part of a clinical trial, and many patients seeking breast augmentation received saline breast implants. Saline implants can look beautiful for the right patient, but they tend to be:
- More prone to rippling, especially in thinner patients
- Firmer compared with modern cohesive gel breast implants
- More likely to have visible edges of the implant when there is minimal natural tissue coverage
Placing implants under the muscle helped in a few big ways:
- Added extra coverage to reduce visible rippling
- Improved softness and the “natural” upper pole look in many patients
- Decreased visibility risk of the implant outline in the upper breast
The muscle covering part of the breast implant helped so much with saline breast implants, as the implants were firm, stiff, and moved in opposition to the breast instead of in harmony with the breast.
The tradeoff is that lifting the muscle may be more disruptive than working in the natural breast space. It can also create movement issues in certain patients called animation deformity (when the implant shifts or moves with every muscle movement). Over the past several years, many patients have moved their implants from below the muscle to above the muscle to treat animation deformity or implant malposition, as the muscle will often push the implant down and out of the breast pocket.
The Modernization of Breast Enhancement Happened with the Development of the Highly Cohesive Gel Implants—Gummy Bear Breast Implants.
As implant technology evolved, especially with the development of highly cohesive gel (“gummy bear”) breast implants, plastic surgeons and patients suddenly had more options in terms of their breast enhancement than they ever did before. These implants are designed to:
- Feel soft, but flow like a natural breast instead of a water balloon
- Maintain better structure
- Reduce the likelihood of visible rippling in many cases (especially compared with older-style saline and earlier gel designs)
- Contain the gel in the breast pocket if a rupture occurs in the breast implant
And as implants improved, surgical technique evolved and changed as we could utilize new implants in innovative ways. As the gummy bear implants became extremely common in breast augmentation procedures, so did above-the-muscle breast augmentation become a more realistic option for select patients. Modern breast enhancement planning and tissue-preserving concepts have further increased the number of breast augmentation surgeries that are performed above the muscle.
What’s the Advantage of Above-the-Muscle Placement?
When an implant is placed under the muscle, you’re adding volume beneath a structure that naturally moves every time you use your chest muscles. For some patients, that can create:
- Movement of the implant with flexing (animation)
- A less natural “shift” during exercise or daily motion
- Discomfort during early recovery, especially in athletic patients
- The muscle can slowly push the implant laterally and downward over time
When the implant is placed above the muscle, it sits in a position that’s more aligned with the breast itself. The implant can move more naturally with the breast, often creating a very harmonious flow and shape.
Preservation breast procedures have become extremely popular as they protect the muscle, ligaments, and the majority of the natural architecture of the breast. For many patients, preserving the pectoralis muscle can mean a smoother recovery and a more natural feel in motion over time. The rapid recovery and ability to do the procedure under sedation rather than general anesthesia have made this a very attractive option for many of our patients.
Will It Look Natural Above the Muscle?
Yes, patients can look extremely natural with the breast implant placed above the muscle.
A natural look depends on several items, such as:
- Your tissue thickness and skin quality
- Chest width and breast footprint
- Implant profile
- Gel cohesivity
- Your desired look (subtle vs. more fullness)
- Size of the breast implant
- How your breast ligaments and internal architecture are managed during surgery
There is not one “best” technique that fits everyone. The greatest thing about modern breast enhancement procedures is that patients have choices.
“Above the Muscle” Refers to Several Options, Including Preservation Breast Procedures
The term “above the muscle” is a general term that encompasses several different surgical techniques. Different planes above the muscle can be utilized via these several approaches, depending on the specific needs of the patient. It really depends on your anatomy and goals. Options include:
- Subfascial
- Subglandular
Preservation-based techniques are designed to respect and maintain natural support structures as much as possible.
Each approach has a different role. Some are better for certain tissue types, breast shapes, or desired aesthetics.
Do Patients Still have Implants placed Under the Muscle?
There are still situations in which placing the breast implant under or half under the muscle is still a good option for patients. If patients have a great breast shape and want to change their implant size, they may be a good candidate for keeping the implants under the muscle.
Discussion with your plastic surgeon about the pros and cons of the breast implant placement above and below the muscle is key to making sure your goals are aligned.
Patients Have Choices and the Ability to Customize Their Breast Enhancement Procedures
In the past, we were limited by the implants available and the techniques that worked best with them for breast augmentation. Today, we’re not bound by those old rules as we have more implant choices and new technology. We also continue to improve our understanding of breast anatomy and the anatomical architecture.
With modern cohesive gel implants and newer, tissue-preserving approaches, patients have more choices than ever for their breast enhancement procedures. We can build a plan around the result you want: natural, athletic, subtle, sexy, or somewhere in between.
If you’re considering breast augmentation and contemplating whether you should have your implants above or below the muscle is right for you, the best next step is a personalized consultation. During your consultation, we will review your goals, your anatomy, and the options that make the most sense for your body. This will allow us to make an educated decision and feel confident in your breast augmentation plan and ultimately your results.
To schedule yours today, please schedule online or call:
Confidence is the best contour.
— Dr. Johnny Franco, Austin Plastic Surgeon