Should Breast Implants Be Placed ‘Under or Over’ the Muscle?


Every woman’s body is different. When it comes to breast augmentation, your body and your preferences will determine the specifics of how your procedure should be done. One of the most critical questions to answer with breast augmentation is where the breast implants should be placed – either under or over the pectoralis muscles in the chest.

In my experience as a plastic surgeon, one option is not better than the other. In fact, it is possible to get a natural looking surgical outcome with either technique, regardless of the shape of the implant. Whether you choose to have implants placed under or over depends on your unique circumstances.

The best way to get a clearer idea of the option you wish to choose for your breast augmentation surgery is to understand the details of each technique. The more you know, the more empowered you are to create a plan with your surgeon.

Under the Muscle Breast Augmentation

‘Under the muscle,’ also known as the dual plane pocket approach, is the most common technique for a breast implant procedure. In this approach, your surgeon will place the implant in the pocket, the actual physical space in your chest, that is located beneath the muscle. In this case, the implant will be covered by muscle in the upper pole, as well as breast tissue in the lower pole.

What are the advantages of having a breast implant placed under the muscle tissue?

  • You’ll have extra tissue coverage, which means your implant will be less noticeable. This may yield a more natural look as it is difficult to perceive the implant beneath your body’s own muscle and breast tissue.
  • There is a more natural take-off in the upper breast slope. This smooths out the transition between the breast and the implant.

While this technique has benefits, it does have a couple of important drawbacks to consider. Because the implant is positioned underneath your muscle, it can potentially interfere with your work or may be an issue if you have a very active lifestyle. There is also the possibility of a certain degree of breast animation, which again, is something you want to keep in mind if you are physically active.

If ‘under the muscle’ doesn’t work for you, ‘over the muscle’ might be your preferred choice.

Over the Muscle Breast Augmentation

‘Over the muscle,’ also referred to as the sub-fascial plane pocket approach, is less commonly used than the dual plane pocket approach but it can still result in natural looking breasts. Around 30 percent of my patients seeking breast augmentation opt for this approach.

With an ‘over the muscle’ procedure, I would place the implant over the muscle but behind the overlying fascia, without cutting the muscle in any way.

What are the advantages of having your breast implants positioned over the muscle tissue?

  • There will be less muscle interference, which means your perception of movement won’t change much after the procedure.
  • If you have an active lifestyle, your breast implants will be less impactful on the existing muscle tissue.

As the breast implant is placed ‘over the muscle,’ you will need to have enough existing breast tissue to provide coverage for the implant. Otherwise, there is a higher chance your implants will be visible after surgery. You’ll need to ensure you have enough tissue coverage to cover the size and dimensions of the implants you want.

Working with Your Surgeon to Personalise Your Procedure

You and your surgeon will need to work together to decide which pocket to use for your unique situation. The amount of breast tissue you already have, the implants you want and your lifestyle will all go into determining the choice you make.

I trust this information will help you make an informed decision.

See our breast augmentation before & after gallery.