Breast Implant Placement

When discussing and deciding  muscle placement with your surgeon, make sure he or she clarifies either PARTIAL or COMPLETE sub-muscular placement.

Implants placed completely beneath the muscle are NOT totally behind the pectoral muscles. The top 2/3 of the implant is behind the pectoral muscles and serratus muscles, and the lower 1/3 is behind the fascia, which is the connective tissue that connects the pectoral, serratus, and upper rectus abdominal muscles. Having the implants completely beneath the pectoral muscles ALONE is not anatomically possible.

Complete sub-muscular placement can be achieved via the transaxillary, periareolar, or inframammary fold incision. However, when going with the transaxillary incision, the muscles and fascia can be left in tact. They do not have to be cut or dissected in any way. This is not so with the periareolar and crease incision. With these two incisions, the muscle must be dissected in one way or another, in order to place the implant behind it. Of course, there is the method of simply cutting, and afterwards, it is closed up with sutures, or allowed to heal on it's own.

Over the Muscle Breast Implant Placement

Over the Muscle - In front of the muscle, and behind the breast tissue.

Pros

• Implants are very easy to place. Virtually all surgeons can perform this procedure with ease.
• Avoidance of a breast lift, or mastopexy, due to mild sag (ptosis), however, this is usually a "quick fix", and a lift will, many times, be needed in the future, especially when larger implants are placed. Keep in mind that the only thing supporting the implant is the skin and breast tissue.
• Less recovery time, with less post-op discomfort/pain, since the muscles are left in tact, and only skin and fat are cut.
• Larger implants may be placed, versus attempting to use a very large implant with partial or complete sub-muscular placement (during the first augment).
• Cleavage is more easily created with overs, particularly if the breasts are naturally spaced wide apart.

Cons

• Ripples are more easily seen and felt, especially in women starting with little or no breast tissue. In these cases, there is very little tissue to help camouflage the implant. This is especially true for textured breast implants placed over the muscle.
• More pictures/views will need to be taken when doing mammograms, and sometimes, insurance companies will not pay for these extra images, which means you will have to pay for those out-of-pocket. However, his can be true no matter where the implants are placed.
• Capsule contracture rates are highest in women with implants placed over the muscle.
• Bottoming out is a larger risk with overs and partial unders than with implants placed in the complete submuscular position.
• Many women who lift weights opt for over the muscle placement. This is mostly due to the fact that when the pectoral muscles are flexed, the implant does not become distorted in shape.
• Overs can give a more "fake", augmented look. There tends to be more of a pronounced "roundness" to the breasts, versus the look that unders give, which is a more natural slope. Again, this is not the case for ALL sub-glandular implants, but does seem to be truer for those who have little to no breast tissue to start with. There is nothing at all wrong with this look. It's simply a matter of personal preference.

Complete Submuscular Breast Implant Placement / Full Unders

Complete Submuscular - The top 2/3 of the breast implant is covered by the pectoralis muscle, and the bottom 1/3 is covered by the fascia.

Pros

• The implant is fully covered, by the muscle and fascia, which helps to camouflage the edges of the implant, as well as ripples in the implant. While visible rippling is possible with all three placements, having complete submuscular placement has the least risk of visible rippling.
• The fascia serves as support to the lower pole, whereas with partial sub-muscular placement, the skin tissues support the weight of the implant. Complete unders serve as sort of an "internal bra".
• Lower risk of capsular contracture.
• Better mammogram readings (vs. over the muscle implants)Lower risk of bottoming out

Cons

• More post-op discomfort.
• Breasts may sit a bit higher at first until the muscle relaxes (same is true with partial submuscular placement.)
• Implant distortion when the pectoral muscle is slightly flexed, which is also true with partial submuscular placement.

Partial Submuscular Breast Implant Placement

Partial Submuscular - The top 2/3 of the breast implant is covered by the pectoralis muscle.
 

Pros

• Decreased risk of visible and palpable ripples and implant edges, except for the lower 1/3 portion of the implant, which is not covered by the muscle/fascia
• Decreased risk of capsular contracture.
• Most of the time, a more natural shape to the upper portion of the breast is achieved. In general, there is a more natural slope to the breast, instead of the "upper roundness" that is can be more common with over the muscle implants. This is a good thing, if this is the look you desire.
• This placement allows for better views during mammograms.

Cons

• More post-op discomfort, and longer recovery period. This is due to the procedure being more invasive, as well as the muscles stretching out to accommodate the implant.
• The implants take longer to "drop" or "settle" into the pocket.
• The breast implant may appear to be distorted while flexing the chest muscles.
• The implants are supported by the same tissues (skin) as over the muscle implants, which means less lower pole support (compared to implants placed completely behind the muscle/fascia), which can possibly lead to bottoming out, although bottoming out is possible with any placement.
• Ripples (wrinkling of the breast implant shell) may been seen and/or felt along the lower and outer 1/3 of the implant (the part which is only covered by the breast tissue). However, ripples are possible with the implants placed completely under the muscle, as well.