Cosmetic Surgery Tips

Breast Augmentation Under Or Over Muscle

We know it can be tough to figure out the best way to get breast augmentation surgery.

That’s why we’ve put together this handy guide to help you decide if you should have your breast augmentation under or over the muscle.

The first thing you should know is that there are two different ways to perform breast augmentation: subglandular (under the muscle) and subpectoral (over the muscle). Each has its pros and cons, so let’s go over them both!

Subglandular Breast Augmentation

In this procedure, an incision is made around each nipple, and fat is removed from beneath your pectoralis major muscle. The implant is then placed under the muscle in a pocket created by your surgeon. This method results in smaller scars than subpectoral breast augmentation but may lead to more capsular contracture than subpectoral breast augmentation does.

Subpectoral Breast Augmentation

In this procedure, an incision is made around each nipple and through one side of your chest wall muscle (the pectoralis major). Then fat is removed from beneath your pectoralis major muscle before an implant is placed under this muscle in a pocket created by your surgeon.

Breast Augmentation Under Or Over Muscle

Under the Muscle Breast Implants vs Over – Which Should You Go For? (Pros and Cons)

There are various important things you need to decide when you choose to have breast augmentation. For instance, you need to choose whether to have implants placed over the muscle or under the muscle.

Although our plastic surgeons will ultimately advise you which is best for your specific breasts (so take this post as information only), in the following post we are going to look at the subject in detail, discussing the pros and cons of each and answering some other important questions.

Is it better to get breast implants under the muscle or over?

It depends, placement is crucial though because the chest muscle can offer extra support for your breast implant and even affect the shape of your breasts if required.

Women who have smaller breasts often prefer to have the implant placed below the chest muscle. It is also recommended to have saline implants placed below your chest muscle.

Let’s look at this subject in a bit more detail though.

There are pros and cons about both so when trying to work out which is best when it comes to implant placement over vs under the muscle, it’s worth considering these.

Under Muscle Breast Implant Placement Pros

Less Chance of Rippling

A common issue is wrinkles or folds in implants, known as rippling, which are noticeably visible through the skin and require an implant revision.

This issue occurs when there is a lack of natural breast tissue to cover over the implant, particularly if the patient has smaller than average breasts or is especially slim.

This can be avoided by opting for under breast implant placement.

Achieves natural breast contouring

Following nicely from above, with slim patients, under the breast placement also offers a more natural breast contour.

Although crucial when saline implants are involved, it is helpful for both saline and silicone implant options.

woman deciding on over vs under breast implants smiling

As saline breast implants contain sterile salt water, also known as saline, which is like the fluid naturally found in your body – if they are placed under the chest muscle, they’ll require some pressure to stop it from having too rounded an upper half.

Although most women nowadays opt for silicone implants, women with thin layers of breast tissue will mean the majority of silicone implants require under muscle placement.

Greater Amount of Breast Tissue is Scannable With a Mammogram

Which can help diagnose and identify breast cancer and other medical issues. It’s important to note that it is safe from a medical standpoint to place implants over or under the muscle.

Under Muscle Breast Implant Placement Cons

Some of the most common risks and concerns regarding under muscle placement includes:

Less Comfortable During The Recovery Period

While this is true, this is only a short-term problem that can be managed with prescribed medication that relaxes your muscles.

Implants Can Be Flattened or Distorted Whenever Your Chest Muscles Are Flexed

This is the number one reason why bodybuilders or women seriously interested in intensive weightlifting are recommended to have over muscle implants rather than under muscle.

Implant Can Be Displaced Over Time

Due to the constant pressure and force of the chest muscle on the breast implant, it can become displaced. This is especially the case when implants with smooth walls are used.

Over Muscle Breast Implant Placement Pros

breast implants selection on table

There is less discomfort and recovery are quicker

While this is a benefit, it is short-lived. Any decision you make about breast implant should be based on the more long-term benefits and results and whether you can avoid complications.

The Subfascial Pocket, Not the Sub glandular, Blunts the Edge of the Implant

The benefit of over muscle placement creates a natural contour

As Breasts Age And Descend Downward Naturally, The Implant Also Descends

This also helps to give implants a more natural look, for a longer period of time.

Will Give a Lift to Breasts of Patients With Naturally Sagging Breasts

When over muscle breast implant placement is opted for, it can help to avoid sagging of breasts in the future, especially if a pre-shaped implant is used.

Over the Muscle Placement Implants Don’t Flatten Out and Move When Muscles Are Flexed

This is referred to as distortion and movement but does not occur in over muscle placement.

Over Muscle Breast Implant Placement Cons

woman before under or over breast implants surgery

Less breast tissue is visible through a mammogram

Although a benefit, we’ve already noted that it is safe medically to have both over and under muscle placement.

Higher Risk of Capsular Contracture

Capsular contracture is particularly a risk if smooth surfaced breast implants are used

Can Increase Chance of Rippling If You Have Thin Breast Tissue

When there is a lack of natural breast tissue to cover implants, it increases the risk of the aforementioned ripples, or highly visible wrinkles or folds.

How long do breast implants under the muscle last?

With modern implants, there is very little difference between the lifespan of over muscle and under muscle implant placement.

Although it will depend on the individual, most women need to have their implants replaced, adjusted, or repaired after about years following breast augmentation, regardless of where they are placed.

Will under the muscle implants get bigger?

A common misconception many women have is that breast implants placed under the pectoralis major muscle will get bigger once they drop and settle.

The truth is that they won’t, implants don’t change size. They do however change size because you eventually lose the post-surgery inflammation and swelling.


If you are interested in breast augmentation, along with the many other things you may have already considered, you need to think about where your implants are going to be placed.

There is a lot of debate about whether implants being placed under or over the pectoralis muscle is best or not.

As we have hopefully shown, there are pros and cons to both and it depends on the surgeon, size of your breasts and your size in general.

Under the muscle breast implants vs. over: what’s the difference and what’s best for me?

When it comes to considering breast augmentation (or breast enlargement), one of the most important questions that you should ask yourself is: “Should I have my breast implants placed under or over the muscle?”.

Unfortunately, there is not a one-size-fits-all approach when it comes to this decision, and the placement you decide depends on a range of factors, such as the results that you are looking for.

If you are considering breast augmentation surgery to help boost your self-esteem and confidence, here we explain the difference between under the muscle breast implants vs over, and examine the pros and cons of both to help you make an informed decision. 

Boob job types

Your first decision is to decide on the type of boob job you want to have. Your options for breast surgery include:

  • Breast enlargement: This will improve the shape of the breast and also increase the size through the use of breast implants.
  • Breast uplift and enlargement: This combines a breast uplift (where the loose skin that forms from breastfeeding, pregnancy, weight loss or ageing is removed and the breast reshaped and lifted) with a breast enlargement to replace the lost volume.

Breast implant types

Next, you need to decide on the type of breast implant that you want to have, there are two main types:

  • Round implants

Think of a typical boob job and we’re sure these implants will come to mind! Round breast implants help to achieve more fullness in the top part of the breast, giving a curvaceous figure that is more in proportion as a result. 

  • Teardrop  implants

These give a more natural, subtle shape as they slope gently from the nipple to the breastbone.

breast implant shapes

Learn more about the difference between teardrop vs round breast implants

The position of your breast implants

Once you have decided on the above, you need to choose your breast implant positioning option:

  • Breast implant under the muscle (submuscular) / dual plane
  • Breast implant over the muscle (subglandular)
breast implant insertion

With breast implants under pectoral muscle, “the muscle” refers to the pectoralis major which is large and fan-shaped. When the breast implant is placed underneath it, the surgeon will detach the muscle from its lower origin along the ribs. As a result, the muscle will only cover about half of the implant, so the bigger your implant is, the less your muscle will cover. 

With breast implant over the muscle, “the muscle” refers to the pectoralis minor and serratus muscles, and the implant will also be placed below the pectoralis major muscle.

Breast implant under the muscle vs over

There are many differences, pros and cons between over the muscle and under the muscle breast implants. Our Consultant Aesthetic and Oncoplastic Breast Surgeon, Mr El-Gammal explains the difference.

Over the Muscle (subglandular)

  • Pros

If you have a moderate amount of breast tissue (such as a B cup or larger), this type of breast implant placement can produce breasts that are very natural looking and will also age well. 

In addition, you will normally achieve your end results in a matter of weeks, and if your implant is placed completely on top of the muscle, you will not experience muscle tightness or breast deformity when the muscle contracts during exercise or day to day activities. 

  • Cons

If smooth implants are placed over the muscle, this may increase the risk of rippling. Around 70% of cases occur in the upper and inner aspects of the breasts, especially when the woman has smaller breasts to start with and has a more slender build.

Furthermore, it is also more likely that you will be able to see the upper edges of the implants too.

Under the Muscle (subpectoral)

  • Pros

When smooth implants are placed under the muscle, the risk of rippling is less than 10%. If you are of a thinner frame, by adding muscle bulk over the upper and inner aspects of the implants, it will be less likely that you will see the visible edges of the implant, and will have a more natural curve to your breast. 

  • Cons

Results may take longer to be achieved, and you may need to wait several months for your breasts to fully recover. It’s also important to be aware that when exercising or completing some normal daily movement, your pec muscle will contract and flatten the implant as it does, meaning they get pushed outward and your breast shape is caused to change. 

In some cases, you may see an indentation along the edge of the muscle, and if you have a moderate amount of breast tissue to start with, then in time, you may get a “waterfall deformity” from sagging, especially if it is lax or becomes lax in time.

Recovery time

When the breast implant is placed above the muscle, the recovery is usually a lot easier and less painful. However, with under the muscle breast implants, you will normally have a longer recovery time, and for several days you may experience quite a bit of discomfort. Following this, it may take several months for any swelling to subside.

What else do I need to keep in mind? 

When considering the pros and cons of breast implants under the muscle vs over the muscle, it’s important to be aware that if placed completely under the muscle, you may have breasts that form a tight half-dome shape. This is not a result that most women want to achieve, so this is a key factor to keep in mind.  

Can breast implants come out from under the muscle?

If you have ever wondered this or whether breast implant under muscle movement will be an issue, then let us explain the risk in more detail. 

If you have under the muscle breast implants, it is possible that they can slip out or move as only the top half of the implant is covered by the muscle. If you are concerned about this, speak to your surgeon.

Key Learnings

When it comes to thinking about whether to have your breast implants placed over or under the muscle, there are a number of factors to keep in mind and speaking to your surgeon will help you to ensure that you get the best results for you and your body.

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