Breast implant placement below or above the muscle: Which is better?

If you have been considering breast augmentation for any period of time, you may be overwhelmed with all the choices available for this procedure. So many advances have been made with available incision locations, implant options, size options, and implant placement options that the first decision is often the most difficult: where to begin!

The good news is, if you have an understanding of the results you desire with this procedure, you will be in excellent hands with Dr. George Alexander during your initial consultation. Together, you and Dr. Alexander will review your desires, health history, and physical anatomy to determine the best options for your cosmetic procedure. Although he will guide you through the entire decision-making process, here is a bit of information about one of your choices: implant placement above or below the muscle.

Like other decisions for breast augmentation, there is no “right” implant placement for all women. Each option has advantages and disadvantages for women who differ from one another in so many aspects. When having cosmetic plastic surgery of the breast, experience matters.

First, we must identify the options available for placement: subglandular, subpectoral, submuscular, and subfascial. Second, we must define our terms:

Subglandular – Placement of the implant above the pectoral muscles but below the mammary gland. This implant placement is also called “retroglandular” or “submammary” placement.

Subpectoral – Placement of the implant below part the pectoral muscle; the lower half of the implant is not covered by the muscle. This placement is also called “retropectoral” and is loosely referred to as “submuscular.”

Submuscular – Placement of the implant not only under the pectoral muscle, but also under related muscles at the lower half of the implant.

Subfascial – The fascia is a thin layer of tissue that covers the pectoral muscles. In subfascial placement, the fascia is separated from the muscle, and the implant is inserted in between. Without adding padding, the fascia can smooth the transitions around the implants while supporting them.

Advantages and Disadvantages

Appearance

As far as appearance is concerned, most surgeons agree that when a women has adequate breast tissue, placement above the muscle will likely result in the most natural breast appearance.

When the breast tissue and skin is too thin and the implant is beneath only that, the implant itself can show through. So for women with average to little breast tissue, placement beneath the pectoral muscle is often preferred to obtain a more natural appearance.

A more natural look is also achieved in placement over the muscle in women who have mild to moderate sagging breast tissue. For those who have severely sagging breasts but prefer submuscular placement, Dr. Alexander will likely recommend a breast lift along with augmentation to provide the best results. If such patients do not opt for a lift along with their submuscular augmentation, they risk the “double bubble” deformity. This can occur because the pectoralis muscle will hold the implant firmly in place, potentially higher than the sagging breast tissue.

Risks

Capsular contracture is one of the more common complications that can occur with breast augmentation. It occurs when hardened scar tissue develops around the implants. Based on clinical studies, many surgeons believe that subpectoral placement reduces the rate of this complication when compared to placement above the muscle. However, capsular contracture can result from factors other than implant placement. Submuscular placement is also preferred to avoid the risk of implant rippling, particularly in thin women who have little breast tissue and choose saline implants.

There are many factors to consider when determining the right implant placement, along with all the other options with breast augmentation. For a better understanding of the breast augmentation process, please consult board-certified plastic surgeon Dr. George Alexander. He will take all of your desires into consideration and recommend the surgical technique that he (and thousands of his patients) have found to create more attractive and beautiful results. To schedule your consultation, please call (702) 242-6776 or fill out our online contact form today.