Should I Have New Breast Implants Placed Above Or Below The Muscle?

Q: Dr. Eppley, Earlier this year I had breast augmentation using 400cc saline implants under the muscle. I really wanted bigger implants above the muscle but my surgeon told me that they would ripple too much and the folds of the implant would be seen when I bent over. I went from a 32A to A DD cup but they don’t look that big at all. I would like to go bigger but still want to look natural. Would I have looked bigger if I had the implants placed above the muscle? If I wanted to go bigger can I have them switched to above the muscle?

A: There are a lot of advantages to having breast implants under the muscle, only one of which is less risk of rippling. Lack of mammographic interference, a less acute transition at the upper pole into the implant, and most importantly, a thicker and more vascularized soft tissue cover. (even if only the upper half of the implant is covered) I think you are confused that there will be some perceptible size difference if the same implant is placed above or below the muscle…there is no appreciable difference. While you certainly can increase the size of your existing implants, I would leave them in the same submuscular location. Being a thin-framed woman I would be cautious about getting too big of an implant that may not have adequate soft tissue support in the long-run. This can result in the breast implants bottoming out, a difficult problem to fix satisfactorily.

Dr. Barry Eppley

Indianapolis, Indiana