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Breast Implants Under the Muscle vs Over: What’s the Difference?

If you’re considering breast augmentation, one important decision is whether to insert the implants over or under the muscle. Of course, this is not a decision you have to make alone. You and your surgeon will discuss your individual case to determine the best placement for the breast implants. Keep reading this article to help you understand the pros and cons of breast implants under the muscle vs over, so you can go to your consultation feeling prepared. 

Why is Breast Implant Placement Important?

There is no one-size-fits-all approach when it comes to breast implant placement. The best method depends on several factors, as well as the results you’re looking to achieve. One of the most important factors in a successful breast enhancement is proper breast implant placement. Where you insert the implants impacts the overall result, so you must make the decision alongside your surgeon, who can offer you the best guidance. 

The chest muscles play a big role in your breast implant placement. Everyone has a slightly different amount of muscle in this region, so this will be a factor in choosing implant placement. The amount of breast tissue will also factor into your decision. You want your new breast implants to look natural and sit properly on the chest. Placement is crucial in the final result of breast augmentation. 

As well as creating the best final result, implant placement also plays a role in preventing complications like capsular contracture and implant rippling. 

Breast augmentation and uplift - 690cc subfasical implants

Breast Implants Under the Muscle vs Over: What’s the Difference? 

Under the skin in the breast, you have adipose (fatty) tissue and mammary ducts. Next, you have a layer of pectoralis major muscle. During breast augmentation, your plastic surgeon makes an incision around the crease of the breast, nipple, and near the armpit and will then need to place the implants over or under the muscle. 

Under the Muscle Implant Surgery 

Under the muscle placement is also known as subpectoral or submuscular. This means that the implant is placed partially under the chest muscles. The pectoral muscles cover about two-thirds of the implant, with the remainder of the implant covered by the breast tissue. 


  • Provides more tissue coverage on the implant 
  • Achieves natural-looking result 
  • Implant placement interferes less with mammogram 
  • Slightly lower risk of implant rippling 


  • Result may take longer to see 
  • Higher chance of implant migrating towards the armpit 
  • Decreased strength in the chest after surgery
  • Slightly longer recovery period 
  • Lateral movement occurs more frequently with this type of placement 

Problems with Breast Implants Under the Muscle

One of the downsides of this type of breast implant placement is that the surgeon needs to detach the pectoralis major muscle. This is what leads to decreased strength in the chest following the surgery. There’s also an increased chance of deformities like double-bubble along the lower pole of the breast.

Breast Implants Under the Muscle Recovery

Breast implants placed under the muscle may require a longer recovery time than other approaches. It’s possible that breasts may feel more painful in the days following your procedure. 

Breast Implants Over the Muscle  

A suitable candidate for placing implants over the muscle has substantial breast tissue (B cup or more). Over the muscle or subglandular placement involves inserting the implant on top of a patient’s chest muscles but underneath the skin, fat, and glandular tissue. 

Breast Implants Under the Muscle vs Over - Breast re-augmentation, Movtiva over the muscle at The Harley Clinic, London

Initially, this breast implant placement was a standard for many plastic surgeons. However, this has changed as it can be easier to see the implants and feel them underneath the skin with this type of approach. Essentially, with over the muscle positioning, the implant sits on the chest muscles.  

Here are the pros and cons of over the muscle implant placement: 


  • Recovery tends to be quicker and easier
  • Chest muscles remain intact 
  • Usually see final results in a few weeks
  • Works for larger implants


  • Higher risk of capsular contracture 
  • Implants may become visible at the top if the patient has large implants and not enough breast tissue.
  • Wrinkling or rippling is easier to see if it does occur
  • Mammograms are harder to read 

What Does Dual-Plane Implant Placement Mean?

Through your research, you may come across dual-plane placement. This technique is neither under nor over the muscle; it’s a middle ground. It involves placing the upper part of the implant under the pectoral muscle and placing the lower part of the implant directly under the breast tissue, over the pectoral muscle. 

It’s a combination of the two techniques and can provide natural-looking and long-lasting results. Using dual-plane implant placement allows the implant to sit in a very natural position. Because the upper part of the implant is under the muscle, you can’t see the edge of the implant, which can sometimes create a more unnatural look. At the same time, the lower part of the implant is covered by tissue only which gives a very natural finish with a youthful lift. 

Here are the pros and cons: 


  • Lower risk of capsular contractor and visible wrinkling 
  • Creates a more natural-looking slope of the breast 
  • Breast tissue is not as obstructed for mammograms 
  • Have the advantages of both under and over the muscle placement 


  • Rippling is still possible on the bottom of the implant 
  • Less support at the bottom of the implant may create a slight risk that you need a breast lift later 

Surgeons often combine the two implant placements to get the benefits of both. This combined approach to implant placement is becoming increasingly popular. 

You also have the option to combine breast augmentation with other procedures like liposuction or a tummy tuck. If you have several areas of concern, combining cosmetic procedures can make the most of one surgery time and achieve a greater impact. 

Breast re-augmentation and uplift after exposed implant - the Harley Clinic

Breastfeeding after Breast Implants 

It is possible to breastfeed after breast implants. During breast augmentation, the implants shouldn’t interfere with the breast ducts or mammary glands where the milk is produced. 

It’s important to know that while breast augmentation doesn’t mean you can’t breastfeed, there are no 100% guarantees. The mother may not have a full supply of milk or already have problems breastfeeding. Depending on the type of incision used during the procedure, breastfeeding could be affected. 

During your cosmetic surgery consultation, your plastic surgeon will talk you through all the risks and potential complications associated with breast implants. If you’re considering having a family after your breast surgery, this is something you should discuss with your doctor. 

Breast Implants Under the Muscle vs Over Q & A

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

Both breast implant placement techniques during breast augmentation are safe, and each serves the client’s specific desires. Therefore, depending on the results you aim to get, one approach may be better. Under the muscle, implant placement is often applied in extremely thin patients or those with less breast tissue since it offers a natural breast contour. Over the muscle implant placement is usually recommended for patients with substantial breast tissue since it appears to lift sagging breasts.

What looks more natural over or under the muscle?

Depending on factors such as age, health history, body type, implant size, and type, one implant placement technique may look more natural. For instance, if you have little natural breast tissue, under the muscle placement would look more natural. This is because the muscle covers the implant, which may give it a more natural-looking result. However, if you have ample breast tissue, over the muscle placement may look more natural since it gives it a moderate natural-looking enhancement.

Before and after breast lift surgery with implants at the Harley Clinic London

Do over the muscle implants sag more?

No, over the muscle implants do not sag more. It is important to note that when considering breast implant surgery, surgeon consultation is essential to help clarify any existing myths. In regards to sagging, what happens is that the soft tissue of the breast may sag over time. This happens irrespective of whether the implant placement is over or under the muscle. Various factors, including ageing and weight gain or weight loss, often cause the sagging of the breast tissue.

Do over the muscle implants look bigger than under the muscle?

Yes, however, this often occurs temporarily, especially after breast surgery caused by swelling. Once the swelling reduces, the implants settle in the breast pockets, giving it a natural look. In addition, this is often impacted by the size of the breast implants you choose to have. However, for those that seek a slight enhancement of their natural breasts, whether it is done over or under the muscle, based on your surgeon’s recommendation, the end appearance is often similar, especially after full recovery.

What is the best breast implant placement?

The best breast implant placement for one person may be different for another. Therefore, there is no one specific breast implant placement that is better than the other. Instead, based on various factors such as the nature of your breast tissue, age, desired outcome, body type, and other factors, your plastic surgeon can recommend the best breast implant placement for you and explain the difference between the two placements. This is why it is important to consult your cosmetic surgeon before the procedure to understand why one breast implant placement is better for you than the other.

Do implants look bigger over or under the muscle?

Immediately after breast surgery to insert breast implants, over the muscle implants often look bigger for a short time. This is caused by the swelling that occurs after surgery and subsides as you recover. Once you fully recover from the breast surgery, your breasts gain a natural-like look.

How to Choose the Right Breast Implant Placement Options

Choosing whether to go under or over the muscle depends on a few different factors, such as: 

  • Individual goals – the shape and size of how you want your breasts to look will be a big factor in the decision process. 
  • Saline or silicone implants – generally, silicone implants are less likely to ripple and wrinkle. 
  • Current health 

Breast Implant Size and Shape 

The size and shape of your implants are important in implant placement. Think about the profile you want, not just the cc’s. When talking about breast implant size, you’re referring to volume. While it’s impossible to guarantee a cup size, your doctor should be able to guide you on the right size for you based on your goals and current body shape. 

Breast implants can be either round or teardrop-shaped, also known as anatomical. With breast implants, you also have different projections so you can have a lot of control over the final look in terms of shape and projection. 

Breast Tissue and Implant Placement Options 

The amount of breast tissue and chest muscle you have will play a significant role in your implant placement decision. Patients with larger chest muscles may be more likely to distort their implants as the chest muscle moves and contracts more. If you have more breast tissue, you would have more natural tissue to cover your implants. 

It’s important that you choose an experienced plastic surgeon who has expert knowledge of human anatomy. Implant placement is one of the most crucial decisions for the success of breast augmentation.  

There is no one perfect approach that fits all patients. Instead, the technique and approach used are based on the individual. That’s why you need a unique approach and expert guidance from your Harley Street plastic surgeon. 

Breast implant placement is critical in achieving the best result possible. The muscles in your chest have a surprisingly big role to play in creating a natural-looking result. While you don’t need to know the ins and outs of breast implant placement, having a good understanding of your doctor’s approach can make you feel more comfortable going into the procedure. 

Like any cosmetic surgery, you should feel completely confident in your plastic surgeon. After all, they are there to guide you on this exciting (and sometimes overwhelming) journey. Ask plenty of questions and get all the information you need before making the decision to undergo breast augmentation. 

Book a consultation today at the Harley Clinic. 

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