Natural, Curvaceous Breast…

Breast augmentation is clinically referred to as augmentation mammaplasty.

Breast augmentation can:

  • Increase fullness and projection of your breasts
  • Improve the balance of your figure
  • Enhance your self-image and self-confidence
  • Breast implants may also be used for breast reconstruction after mastectomy or injury.



Saline implants unfortunately are best placed under the muscle to hide their high incidence of scalloping and wrinkling showing through the skin.

Silicone implants have a more natural feel and transmit wrinkles far less than saline. They can be placed on top of the muscle with far greater success.

In patients with wide cleavage to start with, get better cleavage over the muscle.

Most important, the jumping breast deformity is eliminated by going on top of the muscle.

We are experienced in all approaches to breast augmentation and customize the surgery to the needs and anatomy of the patient. Unfortunately some surgeons perform the same surgery on every patient. Those that place all implants under the muscle, regardless of the patient’s anatomy, have been reported to justify their limited choice with the following arguments:

Implants under the muscle are more natural: False

During the moratorium on silicone from 1991 to 2006, saline implants were in use. Saline implants wrinkle and scallop more than silicone. It was prudent to place saline implants under the muscle to avoid wrinkles in the cleavage area. However the trade off was wider cleavage and the jumping breast deformity. Patients were sometimes told “implants are more natural under the muscle”, because of this.

However silicone gel implants are more natural over the muscle as a general rule. I feel that wide cleavage and jumping breasts are not natural at all. In millions of years of evolution, I am not aware of a mammal that has breast tissue under the muscle. There must be a reason for that.

Implants over the muscle sag faster: False in our experience

In our 35+ year experience, implants under the muscle dislocate and herniate far more often than those placed over the muscle. The constant muscle forces appear to push the implants down and out causing wide cleavage and lateral migration in some patients. About 15% of our breast surgeries is correcting these deformities by repairing the muscle and relocating the implant above the muscle to eliminate jumping breasts and wide cleavage.

Less capsular contracture under the muscle: Not necessarily so

Some studies show higher contracture rates with implants placed over the muscle. However, our 35+ year experience has been that as the quality of implants has improved our capsular contractures rates are similar over or under the muscle. Since no one knows what causes capsular contracture we do not know if our results are due to our meticulous surgical technique averaging less than 5 cc of bleeding, or our use of intraoperative antibiotic irrigation, or pure random luck.

Mammograms are slightly better with implant under the muscle: True


If all breasts were equally soft and pliable and similar size and shape, implants under the muscle a believed to have a small advantage with mammograms. However, in the real world patients heal with different degrees of firmness varying from soft and nearly undetectable to firm and unyielding with severe capsular contracture. Some patients have smaller implants and lots of natural breast tissue and others have very little breast tissue and more implant material. A patient with soft supple breast implants on top of the muscle will have a far superior mammogram to a patient with firm or hard breast implants under the muscle. So the argument has holes. All implants interfere with mammography, so it is important to advise your mammographer that you have implants. They have a special protocol for implants.

My philosophy is that patients come to me for the best looking breasts possible with their anatomy, not the best mammogram. If you are high risk and are concerned about getting optimal mammograms, do not get breast implants at all.

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