17 doctors weighed in:
Does breast augmentation under the muscle look better years later than one on top of muscle?
17 doctors weighed in

Dr. Richard Baxter
Surgery - Plastics
3 doctors agree
In brief: Under maybe better
There are plusses and minuses to implants under the muscle.
Usually there will be a more natuiral look in the upper part of the breast where the muscle conceals the outline of the implant. However, there is the potential for what are called animation deformities which are shape changes when the pectoral muscle is flexed. See a board-certified plastic surgeon for expert guidance.

In brief: Under maybe better
There are plusses and minuses to implants under the muscle.
Usually there will be a more natuiral look in the upper part of the breast where the muscle conceals the outline of the implant. However, there is the potential for what are called animation deformities which are shape changes when the pectoral muscle is flexed. See a board-certified plastic surgeon for expert guidance.
Dr. Richard Baxter
Dr. Richard Baxter
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Dr. Otto Placik
Surgery - Plastics
3 doctors agree
In brief: Snoopy vs RockinSock
A variety of names have been used to describe the long term appearance of breasts with implants which have not "aged" as desired.
When placed under the muscle, implants tend to be held in place by the muscle (gross generalization) while the breast tissue falls off the muscle causing the "snoopy" look. Under the muscle implants age and fall with the breast tissue causing the "rock in the sock" look.

In brief: Snoopy vs RockinSock
A variety of names have been used to describe the long term appearance of breasts with implants which have not "aged" as desired.
When placed under the muscle, implants tend to be held in place by the muscle (gross generalization) while the breast tissue falls off the muscle causing the "snoopy" look. Under the muscle implants age and fall with the breast tissue causing the "rock in the sock" look.
Dr. Otto Placik
Dr. Otto Placik
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2 comments
Dr. Greg Sexton
As long as pregnancy is not a factor, I don't think the final result is any different.
Dr. Tom Pousti
Surgery - Plastics
2 doctors agree
In brief: Under Muscle
Although not universally agreed upon, i think that breast implants placed in the sub pectoral position ( dual plane) do better with time then implants placed in the sub glandular position.
Implants in the sub muscular position tend to be less visible and palpable and are associated with a lower incidence of breast implant encapsulation. Also, interference with mammography is less in this position.

In brief: Under Muscle
Although not universally agreed upon, i think that breast implants placed in the sub pectoral position ( dual plane) do better with time then implants placed in the sub glandular position.
Implants in the sub muscular position tend to be less visible and palpable and are associated with a lower incidence of breast implant encapsulation. Also, interference with mammography is less in this position.
Dr. Tom Pousti
Dr. Tom Pousti
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Dr. Clark Schierle
Surgery - Plastics
2 doctors agree
In brief: Subpectoral Approach
Generally, placing an implant under the muscle will allow it to assume a more natural shape, protect the implant from bacteria in breast tissue from the milk ducts, allow better visualization of breast tissue during mammography, and may lead to fewer complications in the long run such as capsular contracture.
For these reasons we favor a submuscular approach in our practice.

In brief: Subpectoral Approach
Generally, placing an implant under the muscle will allow it to assume a more natural shape, protect the implant from bacteria in breast tissue from the milk ducts, allow better visualization of breast tissue during mammography, and may lead to fewer complications in the long run such as capsular contracture.
For these reasons we favor a submuscular approach in our practice.
Dr. Clark Schierle
Dr. Clark Schierle
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Dr. Ricardo Rodriguez
Surgery - Plastics
1 doctor agrees
In brief: Yes- under is better
Yes- under the muscle looks better. Because of this opinion, it is a very rare exception that i perform breast augmentation over the muscle.

In brief: Yes- under is better
Yes- under the muscle looks better. Because of this opinion, it is a very rare exception that i perform breast augmentation over the muscle.
Dr. Ricardo Rodriguez
Dr. Ricardo Rodriguez
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Dr. Barry Press
Surgery - Plastics
In brief: Complicated question
There is a wide variety of opinion among plastic surgeons on this question.
There are a number of individual factors that impact on the aging of breast implants, including skin quality, heredity, age at augmentation, and relation of implant size to adequacy of soft tissue cover. I don't think it is possible to answer your question accurately for any individual patient (it is predicting the future).

In brief: Complicated question
There is a wide variety of opinion among plastic surgeons on this question.
There are a number of individual factors that impact on the aging of breast implants, including skin quality, heredity, age at augmentation, and relation of implant size to adequacy of soft tissue cover. I don't think it is possible to answer your question accurately for any individual patient (it is predicting the future).
Dr. Barry Press
Dr. Barry Press
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1 comment
Dr. Alex Lechtman
I agree it's a complicated question and I agree with the factors involved. I believe putting the implant under the muscle allows for more likelihood that the implant will stay put while the breast may drop with age. However, anything can happen so it's important to ask these questions to your plastic surgeon.
Dr. Robert Alexander
Surgery - Plastics
In brief: About the same
Breast implants under or on surface of the muscle, assuming there is no capsular contractions do about the same.
Certain types of implants are favored to be placed on the surface, and some submuscular. Seek counsel of your md as to which option is best suited for your implant style, materials, size, and character of your own skin envelope which will cover the augmentation.

In brief: About the same
Breast implants under or on surface of the muscle, assuming there is no capsular contractions do about the same.
Certain types of implants are favored to be placed on the surface, and some submuscular. Seek counsel of your md as to which option is best suited for your implant style, materials, size, and character of your own skin envelope which will cover the augmentation.
Dr. Robert Alexander
Dr. Robert Alexander
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