Breast Implants: Over or Under the Muscle?

Breast Implants: Over or Under the Muscle?

Now that you’ve decided to have breast augmentation, you may be wondering how to decide about implant placement. Will you implant go over or under the muscle? Here, I’ll talk about the pros and cons of each approach and help you understand the terminology.


Under the Muscle Placement

The pectoralis major muscle is the large, triangular muscle in the chest that’s responsible for helping us do push-ups, bench presses, and other pushing and pulling motions. In most women, the lower edge of the muscle crosses the chest a little below the level of the nipple. I can lift that muscle edge and slip a breast implant beneath the muscle, so the top part of the implant is covered by both the muscle and the breast tissue over the muscle. The bottom part of the implant sits directly under breast tissue, since there’s no muscle in this area. You’ll hear this called “under the muscle”, “submuscular”, or “dual plane” technique.

The main advantage of this placement is the added padding over the upper edge of the implant, particularly for thin women. The problem with submuscular implants is that whenever you contract your muscle, the implant will move too. Surgeons call this “animation deformity.” It’s not harmful, but it is a strange party trick! I also see a slightly higher rate of implant malposition problems such as “double bubble” and bottoming out when implants are placed under the muscle, perhaps due to the action of the muscle pushing the implant down and out.


Over the Muscle Placement

Improvements in cohesive silicone gel implants have given us more options, so it’s now also a great option to have implants placed “above the muscle” or “subglandular.” It’s less painful in the short term, but the main advantage is avoidance of that pesky movement that happens with submuscular implants. Subglandular implants are also a better choice for women who may have a bit of “sag” or deflation of their breast tissue, but don’t quite need a breast lift.

My patients often ask if the added muscle coverage is important for protection of their implants. Breast implants are very strong, and the added layer of muscle does little to “protect” the implant from outside forces. Submuscular placement also will not do much to prevent breast sagging over time.  However, there is some evidence that mammograms may be easier for radiologists to read when implants are behind the muscle.

I’ve been in practice long enough to have experience with many different types of implants and with both under and over the muscle implant placement. I tailor the surgical plan to each individual patient, so you can be confident that you’ll receive personalized attention and a plan that’s right for you.

To learn more about your options in breast implant placement, contact Mountain Lake Plastic Surgery at (802) 231-4284.