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

Medically reviewed by T K Sankar, Consultant Plastic and Reconstructive Surgeon

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, and 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, which we explain in more detail below:

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 takeaways

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.

If you would like to improve your confidence, contact us to book your consultation with one of our expert professionals, where you’ll be able to discuss your enhancement expectations and requirements.

Our years of experience in the field of cosmetic surgery ensure that you can rely on The Harley Medical Group to assist you with a tailored treatment programme for breast surgery. We offer consultations with qualified Medical Professionals, as well as a thorough aftercare service to ensure that your experience is positive throughout your entire journey.

Posted June 7, 2021
Book a consultationRequest a callback

Sign-up for our newsletter

Be the first to receive our latest news and offers as well as information on our treatments and procedures.

© 2020 LCHMG Ltd.
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram