When does Dr. Cherny recommend breast implants be placed under the muscle and when on top of the muscle?
Basically, “A” cup patients and small “B” cup patients need under the muscle because the extra padding in needed to pad, protect, and blur the edges of the implant. If the patient has enough padding, a saline implant, which is less expensive, is fine. If the patient is very slim, however, saline will have ripples show through so silicone is much better in the long term. The exception seems to be the Mentor High Profile Saline implant, which tends to run large. This is the only implant Dr. Cherny has noted to have minimal or no rippling on a consistent basis. On top of the muscle is the best way to fill out and lift a breast that has lost volume, skin tone, and has sagged, as happens in pregnancy and major weight loss. This kind of breast, if a full “B” or larger, responds to a submuscular implant by drooping off the implant sooner or later. This is sometimes called the “Snoopy Deformity” (those of you who are old enough may remember Snoopy the dog in the Peanuts comic strip, who had a
