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Breast Implant Placement – The Pros & Cons


When you’ve decided to have a breast augmentation, one of the first options for the patient is where they would like the breast implant to be positioned. An implant can be position either on top or below the pectoralis muscle.


An implant placed above the muscle is positioned between the chest muscle and the breast tissue itself, this is called subglandular placement. An implant that is position under the chest muscles is called submuscular placement. Sometimes this is called “dual-plane” as the implant is below the breast tissue on the lower portion of the breast and under the pectoralis muscle on the top portion of the breast.


Implants placed over the muscle have a more rounded look, which some women feel looks less natural, however women may prefer this look; it’s a matter of personal preference. Pros for going over muscle include less post-operative discomfort due to the muscle staying intact and lower recovery time. For patients with slight sagging caused by excess skin or laxity, but not enough for a breast lift, over the muscle may fill out the breast more as because the implants lie closer to the skin. Cons include higher susceptibility to rippling as there is less tissue covering the implant and the skin is receptive to future stretch marks as the implants are only supported by skin. There is also a higher rate of capsule contracture, which is scar tissue that can form around the implant causing the breasts to harden. If the patient has a breast lift in the future or concurrent with the augmentation, there is also a slightly higher risk with regard to maintaining blood flow to the nipple.


Below the muscle, submuscular placement provides more coverage of the implant resulting in less rippling and palpability of the implants. With this placement pros include, less chance of getting capsular contracture and there is better mammogram detection. With the dual-plane technique, implants are covered by both the breast tissue and the pectoralis muscle, creating a more natural look. Cons include a slightly longer recovery time due to post-operative pain and comfort and breasts may appear to sit a bit high until the muscle fully relaxes.


For the majority of my patients, I recommend under the muscle placement with silicone implants for a more natural look, with a lower risk of complications. One of the few situations where I recommend going over the muscle, is if the patient is a body builder and competing in a lot of shows where the pectoralis muscle is flexed. In that case, the muscle is very active and one gets a lot of animation with the implant. For either placement, there are circumstances based on a patient’s anatomy that one may be more beneficial than the other so it is important to be examined by a plastic surgeon to make an informed decision.


If you have any questions about breast implants, or if you are considering a breast augmentation, and would like to discuss your options more in depth, email me at DrAzad@KamranAzadMD.com to schedule a free consultation.

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