This lady did not wish to be very large after a breast augmentation. She was very active in the gym and had very well developed pec muscles that she did not wish to disrupt. Anatomical breast implants can be placed under the gland and above the muscle and although there are risks of palpability for those with minimal breast tissue sometimes the pros outweigh the cons. Every patient needs to be aware of the pros and cons and risks of pocket placement. This lady often for anatomical breast implants above the muscle and the newer cohesive gel breast implants appear to give longer lasting results and have less of a tendency for palpability and rippling than the earlier generations of implants.