Breast Implant Placement: Over vs. Under The Muscle
During a breast augmentation procedure, an implant may be placed either over the muscle or under the muscle. Multiple factors play a role in determining the optimal implant placement for each individual patient, including patient health history, implant type, implant size, and the patient’s body type.
While an experienced plastic surgeon is in the best position to determine optimal implant placement, it is vital for breast augmentation patients to understand the benefits and drawbacks to each technique.
(Image via Info Plastic Surgery)
Over The Muscle Placement (sub-glandular placement)
The Sublandular technique places the implant between the breast tissue and the chest muscle. Note from the image below that the implant is placed below the glands of the breast which does allow for breast feeding.
- Surgical procedure is much slightly easier and perceived as less invasive.
- Lower recovery time and post-operative discomfort as the muscle stays intact.
- Generally more cleavage can be created because the implants can be placed slightly closer together.
- Larger implants can be utilized depending on the soft tissue characteristics of the patient’s breasts.
- Implants do not become distorted when the pectoral muscles are flexed.
- Generally results in a less natural (more augmented) look where there is a pronounced roundness to the breast. Some women may prefer this look; it’s a matter of personal preference.
- Implants are solely supported by the shin which could result in future stretch marks and blemishes.
- Breasts are more susceptible to visible rippling as there is less tissue covering the implant along the upper border.
- Creates more mammogram distortion which requires more views to be taken.
- The rates of capsule contracture tend to be higher.
- Increased risk of the implant “bottoming out”.
- Future or concurrent breast lift procedures become more risky with regard to maintaining blood flow to the nipple.
Under The Muscle Placement (sub-muscular placement)
Sub-muscular placement is a technique in which breast implants are placed partially under the pectoralis major chest muscle.
- Results tend to have a more natural look as the implants are covered by both the breast tissue and the pectoral muscle.
- Reduced risk of visible rippling.
- The muscle supports the placement of the implant reducing the wear to the skin.
- Reduced risk of capsular contracture development.
- Less distortion of mammograms.
- Decreased risk of the implant “bottoming out”.
- Safer choice for those seeking concurrent breast lift or those who may need a lift in the future as it preserves better blood flow to the nipple in these settings.
- Surgical process is more slightly more difficult and perceived as more “invasive.”
- Longer recovery time mainly due to more post-op pain/discomfort.
- Breasts may appear to sit a bit high until the muscle fully relaxes (about 4-6 weeks after surgery).
- Implants can become distorted when the chest muscle is flexed.
- Depending on the patient’s body type larger implants cannot be utilized.
Given this, the women I am most likely to recommend over the muscle placement are generally those opting for silicone breast implants and have a good amount of their own breast tissue, and in those patients with very large or strong chest muscles (ie body builders). When there is a significant amount of breast tissue, there will be adequate soft tissue coverage making the pectoralis muscle superfluous in this regard. Also, those with robust chest muscles are more likely to have significant distortion on animation and should consider subglandular placement. Silicone implants are preferred for subglandular placement due to their more natural look and feel compared to saline implants.
In most cases, I recommend submuscular or “dual plane” placement with silicone gel implants. This gives a natural, long lasting result for most patients and yields the lowest complication rate. Further, it facilitates future breast lifting procedures by preserving the best blood flow to the nipple.