Over the Muscle Breast Implant vs. Under the Muscle Implant

Over the Muscle Breast Implant vs. Under the Muscle Implant

Breast implant surgery (Augmentation Mammaplasty) is an extremely popular procedure for women who want to change the size and shape of their breasts.  The final outcome of the breasts after implant placement is mainly determined by the relationship of the implants to the pectoralis muscles of the chest wall.  Breast implants are referred to as “overs” and “unders”; these terms refer to whether the implant is being placed over or under the pectoralis muscles of the chest wall.

Breast implants are devices, which may be filled with elastic silicone gel or saline solution. For the past ten years, there have been studies conducted to determine whether silicone gel-filled implants are associated with cancer or connective tissue disease; at this time, there is no evidence that breast implants are associated with these diseases.

The “Under” Approach
With the “under” approach, the implants are totally behind the breasts. The advantages of this approach are ease of placement, there is no implant visibility, no rippling of the implant surface, low mammography interference, and no scars left on the breast. The disadvantages of the “under” approach are that the surgery is much more difficult to master, and there is post-operative muscle discomfort.
After breast implant placement, you will typically have drainage tubes in place for approximately two days. Stitches are used to close the incisions, and a bandage will be applied over your breasts to assist in healing. You will feel sore and tired for several days after surgery, but most patients are up and around within 48 hours after the procedure. Within a few days after surgery, you should feel well enough to return to work, depending on what type of job you have. Women are to refrain from upper body exercise for up to six weeks and lower body exercise for approximately three weeks.

The “Over” Approach
In the “over” approach, the implants are actually inside the breast. Some of the advantages of this approach are the surgery is fairly easy to perform and can be accomplished by almost any surgeon; there is less post-operative discomfort; and this procedure allows for the insertion of oversize implants, which some women want.
However, there are several disadvantages to the over approach, and many plastic surgeons do not recommend this type of implant. Some of the disadvantages are the implants interfere with mammograms; there is clear visibility of the implant edges (and they can be felt, also); and there is visible rippling of the skin over the implants.

There are many reasons women consult a cosmetic surgeon to discuss breast implant surgery:

  • To improve the shape of sagging breasts
  • To provide the foundation of breast contour after a mastectomy for breast cancer
  • To improve appearance or create the appearance of a breast that is disfigured or missing due to heredity, congenital deformities, or trauma
  • Feels breasts are too small
  • To restore breast volume after weight loss or pregnancy
  • To achieve better symmetry in shape/size of the breasts

Getting breast implants can be a very thrilling and satisfying experience that often makes women feel better about their appearance boosting their self-confidence. Your decision to have breast implant surgery is a personal decision that not everyone will understand. Breast augmentation can certainly enhance your appearance and your self-confidence, but it may not cause people to treat you differently. Your plastic surgeon can discuss breast surgery options with you at the time of your initial consultation.
If you would like to learn more about the types of breast augmentation available to you, please contact Plastic Surgeon M. Kirk Moore, M.D.  Dr. Moore sees patients in Salt Lake City, Utah.
We look forward to hearing from you with any questions or concerns you may have about breast augmentation surgery or other cosmetic surgery procedures we offer. We welcome your calls at or feel free to email us for more inforation.