American Society of Plastic Surgeons
For Medical Professionals
one year ago

Breast Lift and implants OTM vs UTM

I have had a few consults and need a lift and small implants for what I am hoping for. Right now I’m struggling with OTM or UTM. I apparently can do either but one PS said they would sag sooner with OTM. Just wondering what others have done and feedback. I do workout regularly and wonder which is the best. I’m 47 with 3 degree postis. Thanks!

Procedure: Breast Lift
Location: blythewood, SC

Replies 4

Ellis Tavin
ASPS Surgeon
Add to Favorites

I am not aware of any study that demonstrates an earlier recurrence of sagging with one plane of implant placement vs. another. There are several factors to consider in choosing to go above or below the muscle. One consideration is what is called animation deformity which is when the pectoralis muscle contracts causing the breast to jump. If you regularly flex your pecs during exercise, you may want to go above the muscle to avoid this.

Daniel Allan

It is my belief and for 40 years my practice was to place the implants under the pectoralis muscle. (In reality, only the upper half to two thirds is under the muscle). Because:

1. The muscle camouflages the border between the implant and the woman's own tissue.

2. There is a lower incidence of capsular contracture. The muscle is a large pad of well-vascularized tissue between the breast tissue, the ducts of which

are known to harbor bacteria, and the implant, which is a large foreign body, the presence of which promotes infection.

3. Placing the implant UTM throws the breast into better profile for mammography.

4. Placing the implant UTM means the pectoralis muscle bulk is added to the breast mound. producing a greater degree of augmentation for a given size


While "animation deformity" is real, I never had a patient complain about it.

While you don't mention it, I recommend smooth saline implants. Lastly, other surgeons may disagree with me.

Alfred Antonetti
ASPS Surgeon

Two ways of doing things and one not clearly better. You have had several consults already. Just make up your mind with the surgeon that you like the best.

Tanongsak Panyawirunroj
ASPS Int. Surgeon
Add to Favorites

Currently dual plane technique (Upper part under the muscle and lower part over the muscle) for breast augmentation combination with breast lift may correct your breast problem and give the most natural result.


Patient Care Center