When a woman gets breast implants, the implant can be placed either over or under the pectoral chest muscle. There are pros and cons to each placement, which a surgeon will consider when recommending the best option for the patient. As a patient, there are some simple ways you can tell whether your implants were placed above or below the muscle.
Appearance
The appearance of breasts with over vs under the muscle implants differs in subtle ways:
- Over the muscle implants tend to look rounder and fuller, with more cleavage.
- Under the muscle implants have a gentle slope from the top of the chest, with less pronounced cleavage.
- Over the muscle implants sit high on the chest, while under the muscle implants sit slightly lower and more natural.
- With over the muscle implants, you may be able to see or feel ripples or edges of the implant under the skin. This is less noticeable with under the muscle.
However, these differences are subtle and can vary from person to person. The placement alone does not drastically change the look of the breasts or implants.
Feel
When touching your breasts, you may be able to feel differences between over and under the muscle implants:
- Over the muscle implants will feel fuller at the top of the breast, with a distinct rounded edge.
- Under the muscle implants will have more thin tissue covering over the top, with a softer transition into the natural breast tissue.
- Over the muscle implants tend to be more firm, since they have less natural tissue on top.
- Under the muscle implants may feel more natural, with breast tissue able to drape over the implant.
However, individual factors like breast size, skin thickness, and amount of natural breast tissue can affect the feel. Implant feel also changes over time as they settle into position.
Movement
The way your breast implants move when you change positions or flex your chest muscles also differs between over and under placement:
- Over the muscle implants stay still when you contract your pectoral muscles.
- Under the muscle implants will move downward and inward slightly when you flex.
- Over the muscle implants tend to move as one unit with your breast tissue.
- Under the muscle implants move independently from the overlying tissue a bit more.
This is because the pectoral muscle covers part of the implant when placed underneath. The movement of that muscle then also moves the implant.
Visibility of breast fold
Looking at your breasts from the side, the fold under the breast may appear different with over vs under the muscle implants:
- Over the muscle implant edges can sometimes be visible along the breast fold, looking like a faint line.
- Under the muscle implants will have a smoother transition at the breast fold since tissue covers the implant edge.
However, in some cases over the muscle implants can still have natural, hidden edges. Visibility depends on factors like implant size, skin elasticity, and natural breast anatomy.
Changes over time
As breast implants settle into position over weeks and months, their appearance and feel evolves. But the differences between over and under the muscle placement remain, including:
- Over the muscle implants tend to stay fuller on top over time.
- Under the muscle implants settle lower and look more sloped.
- Over the muscle implants may become more visible or palpable due to thinner tissue coverage.
- Under the muscle implants are less subject to thinning tissue and implant rippling over time.
However, these changes happen gradually and you may not notice a drastic difference. Your surgeon can explain what to expect long-term with your specific implant placement.
Imaging Tests
If you are still uncertain whether your implants are over or under the muscle, certain imaging tests can help provide an answer:
- Mammogram: On a mammogram image, an under the muscle implant will be partially obscured by the pectoral muscle. Over the muscle implants sit higher and are more visible.
- Breast ultrasound: An ultrasound can show the implant’s position relative to the muscle tissue. Under the muscle implants sit beneath the thin pectoral muscle layer.
- MRI: A breast MRI provides a detailed 3D view of the implants. The pectoral muscle covering part of an under the muscle implant will be clearly visible.
Your doctor may recommend imaging if they need to confirm the implant placement while evaluating a concern like breast pain or asymmetry. Let your provider know if you do not already know the placement location.
Surgery Records
If available, the operative report from your breast augmentation surgery will definitively state whether the implants were placed above or below the muscle. This medical record provides details about the surgical procedure from your surgeon. Contact your surgeon’s office to obtain a copy of your operative report if you still have uncertainty about the implant placement.
Ask your surgeon
Consulting your plastic surgeon is the best way to confirm the placement of your breast implants if you remain unsure based on appearance, feel, imaging tests, or don’t have access to your records. Your surgeon can definitively tell you whether they positioned the implants over or under the pectoral chest muscle at the time of surgery. They will assess the current placement and help explain the pros and cons of each option.
Conclusion
While differences between over and under the muscle breast implants can be subtle, there are some telltale signs you can look and feel for. The appearance, feel, movement, and imaging results of your breasts may all offer clues about the implant placement. Checking past surgical records or consulting your surgeon can provide a definitive answer if you remain uncertain. Being informed about your breast implant placement is an important part of your health history.
