Over vs Under – What does that really mean?

breast augmentation in long island | Dr. Mark Epstein If you seriously start to discuss breast augmentation with your friends, over vs under is certainly going to come up.  But what does it really mean when you are talking about a breast implant?  Pocket location is one of the key decisions in breast augmentation operative planning.  Choosing the proper pocket location is key to getting not only a more natural appearing result, but a result that is likely to age better with you and facilitate the best cancer screening long term.

When most of your friends say, “Mine are under,” they think that their entire implant is placed completely under the muscle.  The muscle they are referring to is the pectoralis muscle.  The pec runs across your chest kind of like a Miss America sash.  So if the entire breast implant sat “under” pectoralis, it would look more like a shoulder pad!  What your friends should be saying is that their implant sits partially under the muscle or partially retropectoral.  In reality, only the upper third of the implant sits partially under the muscle.  The criteria for choosing the proper pocket location goes back to measurements for Dr. Epstein.  If there is less than 2 cm of pinch thickness in the upper portion of the breast, then he needs more of your soft tissue to cover the implant giving you a smooth natural transition in the upper portion of the breast allowing you to see and feel you in that thin area, not see and feel implant edges.

There used to be two negatives to placing the implant partially under the pectoralis muscle.  One would be lateral displacement of the implant over time and the other was a more painful recovery.  Today, Dr. Epstein uses a techniques called Dual Plane which allows the implant to be placed partially subpec, but eliminates those two tradeoffs – no more lateral displacement of the implant and you can still be up and out to dinner the night of surgery!

Placing the implant partially under the muscle is also the preferred location for ease of breast screening and mammograms.  Every radiologist on the planet would prefer that a breast implant be placed partially under the muscle for ease in imaging.  After implants, mammography techs will do regular mammogram views of the breast and then something called the Ecklund technique, or push back views, so that they can image around the implant.  Having the implant placed partially behind the muscle makes all of this process easier and safer for you long term.

Everyone would like to think they have a choice in whether their implant should go “over” or “under” but in reality, when a woman wants a breast implant, what are the chances that she has more than 2 cm of pinch thickness in the upper breast?  If she did, she probably wouldn’t be looking for an implant!  Dr. Epstein will measure you and discuss all of your options with you during your consultation and will always be sure the pocket location choice is the best and safest option for you and your tissue!


To schedule a consultation with Dr. Mark Epstein please contact our Stony Brook office at 631-689-1100, or request information here.


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