08/27/2025
Please excuse the shadows and unprofessional background in the afters—I had to go across the pond to get these 11 YEAR postops. But while the pics are not perfect they do demonstrate an important point in : the main difference between implants placed OVER or UNDER the muscle.
When this 56 year old woman came to me she had 20 year-old implants OVER the muscle with:
*Baker III capsular contracture creating that “two balls on the chest” look and they were rock hard.
*Sagging of her breast footprint on the chest wall
The procedure I performed was:
silicone and replacement with new ones “under the muscle” or through her pre-existing incisions
11 YEARS LATER they remain soft and much more natural-looking because she is thin with very little breast tissue and the upper poles of the implants are blunted with the muscle coverage. AND they are actually less saggy than the others when she was YOUNGER.
It is important for patients to understand that while there is a small risk of animation deformity with an implant at least even partially under the muscle, when someone has a thin chest wall with small breasts to begin with, in my opinion placing them or “over the muscle” actually looks less “natural.”
In addition, historically most breast implants have a lower rate of capsular contracture under the muscle vs over.
In summary:
It is counterintuitive but generally breast implants look and feel more natural with a lower capsular contracture rate when placed under the muscle.
Fat grafting CAN help camouflage the top border of the implant but it is not completely reliable.
Personally, I would almost always recommend the or approach.
Honestly, animation deformity in cosmetic breast augmentation is rarely a complaint and is more common in breast reconstruction.
