Breast Implants: Above the Muscle vs. Below – Which is Best?
Posted July 02, 2025 in Breast Augmentation, Breast Implant Replacement, Breast Implants
By Dr. Chris Patronella
One of the most common questions that I hear when I’m seeing a patient who is in the office to be a evaluated for breast augmentation with breast implants, whether they have implants already or they’re looking to have breast implants placed, is “What’s the deal with above or below the muscle placement of implants?”
When the first breast implants were introduced in the1960s, all breast augmentations were performed above the muscle. Subsequently, it was recognized that implants placed above the muscle tended to form capsular contracture more often. So an attempt was made to put the implants under the muscle to see if that would reduce the chance that a capsular contracture would form—that is scar tissue which wraps around the implant and makes it feel very hard and sometimes distorts it. And in fact, taking that step did indeed lessen the occurrence of capsular contracture.
Below the Muscle Implants: The Advantages
This leads us to the two primary advantages with below the muscle implants:
- It lowers the risk that scar tissue will envelop the implant and cause it to feel hard and also move the implant upward into an unnatural position.
- Positioning implants under the muscle provides more tissue to camouflage the upper part of the implant so that it’s less noticeable to the eye.
Below the Muscle Implants: The Disadvantages
Now, let me explain the disadvantages of placing implants under the muscle, because there are issues to consider with this approach as well.
- The implant tends to wiggle when you contract the pectoral muscle, which causes the implants to look unnatural. In addition, for those who like to work out—lift weights and strengthen their pectoral muscle—the implant can slide upward and feel hard. So under the muscle implant placement is not particularly a great idea in a woman who likes to lift weights.
- Implants placed below the muscle are more likely to “bottom out” because the muscle can detach, causing the implant to slide below the breast fold.
Above the Muscle Implants: The Advantages
- It’s an easier postoperative recovery because the muscle isn’t involved, and it doesn’t hurt as much.
- It provides a slight lifting effect on the breast; therefore, in someone who has mild sagging, not severe, the implant can actually lift the breast just a bit so they are less likely to need a breast lift in that circumstance.
- Patients who like to lift weights are able to lift weights because it doesn’t really alter the position of the implant at all. And it’s less obvious when contracting the pectoral muscles when the implant is above the muscle—it doesn’t wiggle the same way as the implant does when it’s under the muscle.
Above the Muscle Implants: The Disdvantages
- It’s easier to see the edge of the implant—it’s more noticeable—in women who are very thin and have small breasts. Generally speaking, a woman with an A-cup or small B-cup breasts is going to be a better candidate for having implants placed under the muscle.
- There’s a moderately higher capsular contracture rate when the implant is above the muscle. However, this doesn’t seem to be the case with the Motiva implant—a newer implant I’m using. The Motiva implant has provided a tremendous advantage because it can be placed above the muscle, giving us a suitable alternative for women who have enough tissue to camouflage it.
- In a thinner patient with very small breasts, it’s easier to see the edge or even a ripple in an implant in the upper part of the breast.
So that’s an overall summary of the pros and cons of implant placement options. The most important consideration is this: Each patient has individual characteristics which dictate my recommendation for the implant location. During my consultation with a patient, I evaluate these details in order to make a recommendation that takes into consideration a woman’s unique anatomy, her stature, and lifestyle so we can come up with a good individual plan that is tailored to her needs and aesthetic goals.
Contact us today to schedule your in-office or preliminary video meeting with Dr. Patronella.