The short answer to this question is that it depends. What follows are some of the factors that go in to making an informed decision on breast implant placement, specifically, whether it should be placed over or under the muscle.

For starters, the muscle being discussed if the pectoralis major muscle; put yours hands together and press and that is the muscle we are talking about (it is the same muscle used for planking or push ups). If you decide upon a saline implant, the recommendation is to place the saline implant under the muscle the vast majority of the time. Because the saline implant is easier to detect by sight and feel and the muscle offers additional coverage of the upper half or two thirds of the implant, saline implants are generally placed under the muscle. Gel implants, because they are harder to detect, can go over or under the muscle. With enough breast tissue of your own, for example about 2 centimeters thickness when pinching, the implant will be hard to detect.

So the question arises, why go above the muscle? There are several advantages in breast implant placement above the muscle; less pain, quicker recovery, a tendency to a more natural appearing result, an absence of implant distortion with muscle contraction in the short term and implant bottoming out in the long term. Breast implant placement above the muscle does have its cons though; increased chance of seeing ripples and the possible need for additional imaging during mammography. See below for a quick reference.

Above the Muscle

  • More risk of ripples
  • Less pain
  • Less recovery
  • Implant does not move with muscle contraction
  • Less risk of bottoming out
  • Tends to more natural appearance
  • May need more views on mammogram
  • Tendency to narrower cleavage

Below the Muscle

  • Less risk of ripples
  • More pain
  • More recovery
  • Implant moves with muscle contraction
  • More risk of bottoming out
  • Tends to less natural appearance
  • Less effect on mammogram
  • Tendency to wider cleavage

The bottom line is that for the best recommendation, schedule a consultation with a board-certified plastic surgeon to review the pros and cons in detail and help you make the best and most-informed decision.