Whether a breast implant goes under or over the chest muscle, which shape it has and how big it is are decided together at a consultation, from your measurements, your own breast tissue and the look you want. No single combination is right for everyone, and the surgeon has the final say on what is safe for your body. This guide explains each choice so you know what to ask.

Placement: over the muscle, under the muscle, or dual plane

There are two basic “pockets” for an implant. The American Society of Plastic Surgeons describes them as subglandular (behind the breast tissue, over the chest muscle) and submuscular (under the chest muscle), and says the choice depends on the type of implant, how much enlargement you want, your body type and your surgeon’s recommendation.

Over the muscle (subglandular)

The implant sits directly behind your own breast tissue. With enough natural tissue to cover it, this gives a full, well-defined shape, and the implant does not move when you tense your chest. The trade-off: in slim women with little tissue, the implant edge or some rippling can be easier to see or feel.

Under the muscle (submuscular)

The upper part of the implant sits beneath the chest muscle, which adds an extra layer of padding. This can give a softer slope at the top of the breast, so it is often suggested for people with very little natural tissue. The breast may change shape slightly when the muscle contracts, which regular gym-goers sometimes notice.

You may also read about “dual plane”. It is a variation of under-the-muscle placement: the upper part of the implant is covered by muscle and the lower part sits behind breast tissue. Whether it applies to you is a technical decision for your surgeon.

Incisions: where the scar goes

Every implant needs an incision, so some scar is unavoidable. ASPS lists the main options as the fold under the breast (inframammary), the edge of the areola (periareolar) and the armpit (axillary), and says the choice depends on the implant type, how big a change you want, your anatomy and the surgeon’s preference. The breast crease is the most common choice because the scar usually sits in the fold and is hidden by a bra or bikini top.

The NHS notes that scars should start to fade around six weeks after surgery, but also that scars can sometimes be thick and noticeable, so it is worth being realistic. Mention any history of raised or keloid scars.

Implant type and shape: round or teardrop, smooth or textured

• Silicone and saline. Both have a silicone shell. Silicone gel tends to feel more natural; the NHS notes saline implants are more likely to fold or deflate over time. Our surgeons use silicone implants, with brand and type confirmed in writing before you book.
• Round implants look the same from every angle, so turning in the pocket is not a visual concern, and higher-profile versions give more forward projection.
• Anatomical (teardrop) implants are fuller at the bottom. ASPS notes that shaped implants can rotate, which may give an unusual appearance and need another operation, and that they need a slightly longer incision.
• Smooth and textured surfaces. Smooth implants feel soft and move with the pocket; textured ones grip the tissue but are more strongly linked with the rare condition BIA-ALCL (see below). Ask which surface yours has.

Choice	Main options	What usually decides it
Placement	Over the muscle; under the muscle (including dual plane)	How much natural tissue covers the implant, your build, how active you are, the look you want
Incision	Breast crease, edge of the areola, armpit	Implant type and size, your anatomy, surgeon’s preference
Shape	Round; anatomical (teardrop)	Your starting shape and the upper-pole fullness you want
Size	Measured in volume (cc), not cup size	Chest measurements, skin stretch, tissue thickness, lifestyle
Lift	Implant alone; implant plus lift; lift alone	How far the nipple and breast have dropped, skin quality

How the size is chosen

Implants are measured by volume, not cup letter; bra sizes vary too much between brands to be more than a rough guide. Size usually rests on:

• Chest measurements: the width of each breast, the gap between them and nipple-to-crease distance. An implant wider than your breast base tends to look unnatural.
• Skin and tissue: stretch and thickness decide how much implant they can safely cover over the years.
• Lifestyle: running, riding or physical work often point towards a more moderate size.
• Trying it on: sizers (trial implants worn in a bra) or result photos help you picture volume, though not the final healed shape.

For your online consultation, send clear photographs, your height and weight, your bra size and a few photos of results you like and dislike. The surgeon recommends a range and explains why, and will not fit an implant larger than is safe for your body.

When a lift is needed with, or instead of, implants

Implants add volume; they do not lift skin. ASPS says augmentation does not correct severely drooping breasts, and a lift may be recommended at the same time or separately. A useful sign: if your nipple sits at or below the breast crease, an implant alone may simply add weight to a low breast.

If the main concern is emptiness at the top, an implant may be enough; if it is sagging with acceptable volume, a lift alone may suit you better. Read more on our breast lift page for South African patients. The surgeon decides which of these fits you after seeing your photographs.

How long breast implants last, and what monitoring means

Implants have no fixed expiry date and are not swapped on a timetable. But the US Food and Drug Administration states plainly that “breast implants are not lifetime devices”, and that the longer you have them, the more likely you are to need them removed or replaced. The NHS notes some women need further surgery after about ten years, because of the implant or changes in the breast itself.

In practice, monitoring means:

• Knowing how your breasts normally feel, and seeing a doctor promptly about new swelling, lumps, hardening, pain or change in shape.
• Regular check-ups with a doctor at home. For silicone implants, the FDA says your doctor may recommend periodic ultrasound or MRI scans to check for silent rupture.
• Telling the radiographer about your implants before any mammogram.

A calm word on BIA-ALCL

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare immune-system cancer that can develop in the scar tissue around an implant; it is not breast cancer. The FDA and the UK regulator, the MHRA, both link it more with textured than smooth implants. The usual sign is painless swelling from fluid around the implant, typically years after surgery. Neither regulator recommends removing implants in people who have no symptoms. If you notice swelling or a lump more than a year after your operation, contact your surgeon and your GP.

Your implant card and records: what to bring home to South Africa

Your long-term care happens at home, so before you leave İzmir make sure you have:

1. Your implant card (patient device card) showing the manufacturer, model, size, surface and lot or serial numbers of each implant.
2. The operation note: placement (over or under the muscle), incision site and the date of surgery.
3. Your discharge summary with medicines, wound care and the checks agreed before your flight.
4. Digital copies of all of these, as well as paper.

Show them to your GP and to any doctor or radiographer who examines your breasts in future. If a safety notice ever concerns an implant model, these records tell you whether it applies to you. Follow-up with our team continues online and on WhatsApp after you fly home; Turkey is just one hour ahead of South Africa.

When this may not be right for you, or staying in South Africa may be better

Surgery in South Africa may suit you better if:

• You want your surgeon close by for every follow-up, or could not travel back if a revision were needed.
• You cannot take time off for a longer stay before the ten-hour flight, or a history of blood clots makes long-haul travel after surgery unwise.
• You are still planning a pregnancy or expecting a big change in weight soon; many surgeons suggest waiting until things are stable.
• You are unsure which size or look you want. Take your time; an implant is a long-term commitment.

Frequently asked questions

Does under-the-muscle placement make implants look more natural?

Not automatically. The extra muscle cover can soften the upper edge of the implant in women with little breast tissue, but in women with enough tissue an over-the-muscle placement can look just as natural. Your surgeon recommends the placement that suits your build.

Are round or teardrop implants better?

Neither is better for everyone. Round implants look the same from every angle and are widely used; teardrop (anatomical) implants are fuller at the bottom but can rotate and need a slightly longer incision. The right shape depends on your starting breast and the result you want.

How do I know what implant size to choose?

Size is chosen in volume, not cup size, from your chest width, skin stretch and tissue thickness, plus your lifestyle. Sizers and photographs help you picture it, and the surgeon recommends a safe range for your body.

How long do breast implants last?

There is no fixed expiry date, but implants are not lifetime devices. The longer you have them, the more likely it is that you will need them removed or replaced at some point, so regular check-ups with a doctor at home are recommended.

Should I worry about BIA-ALCL?

BIA-ALCL is rare and is more often linked with textured implants. Regulators do not recommend removing implants in people without symptoms. See your surgeon or GP if you notice new swelling or a lump, especially years after surgery.

Read our guide to breast augmentation in Turkey for South African patients, then book a free online consultation or message us on WhatsApp. Since 2005 our own team has looked after every patient personally, and treatment is backed by our one-year treatment guarantee. More help for travellers is on our South Africa patient hub.

Sources

• US Food and Drug Administration (FDA): Breast Implants
• FDA: Things to Consider Before Getting Breast Implants
• FDA: Questions and Answers about BIA-ALCL
• MHRA (GOV.UK): Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)
• NHS: Breast enlargement (implants)
• American Society of Plastic Surgeons (ASPS): Breast Augmentation
• ASPS: Types of Breast Implants
• ASPS: Breast Augmentation Procedure Steps