Breast Implants Under or Over the Muscle?

So you’ve decided to get breast implants – or are at least very seriously considering it – yet aren’t sure exactly how you want them done. If so, you’re in good company – virtually every woman who considers breast augmentation has at least one question about the procedure and the results.

One common question I receive is this: Should I have my implants above or below the muscle? Patients undoubtedly hear good stories and “horror” stories about each approach, so we’ll talk about each approach here so you can make an informed choice with your plastic surgeon.

Above the Muscle Implants

One option for breast implants is to have the implants rest above the muscle in your chest, also known as a sub-mammary (or sub-glandular) placement. The muscle we’re talking about is the pectoralis major muscle, the largest single muscle in your upper chest.

Choosing to place your implants above your pectoralis major muscle – and thus below your breast – gives you several benefits, including:

1. More lift and less natural sag than implants under the muscle
2. No movement of the implant associated with muscle contraction
3. Normal strength and function of the muscle
4. Quicker recovery on average than other types

Note that with this procedure, the implant is more likely to be seen in the upper part of the breast, and may lead to a slightly less natural look if you are very thin.

Under the Muscle Implants

An alternative to sub-glandular placement is sub-muscular placement, in which the implant is inserted beneath the pectoralis major muscle with what is called a “dual plane” augmentation in which the upper portion of the implant is covered with the pectoralis muscle and the lower portion of the implant is covered solely with breast tissue.

This type of placement gives several different qualities in contrast to sub-glandular placement, such as:

1. Less implant visibility in the upper part of the breast
2. A possibility of a slight loss in strength to your normal muscular functions
3. Movement of the breast when exercising because the implant is beneath the muscle
4. Slightly longer recovery and more discomfort after surgery (when compared with over the muscle techniques)

Choosing the Right Approach

As with any major medical decision, you should arrive at a choice only after consulting closely with your plastic surgeon. Be honest and open; tell him or her exactly what you want, and let them guide you to the right choice with your input.

Note that in any case, the smaller the implant, the more natural the look (because you have more breast tissue available to hide the implant). Since implant size is a major factor, take that into consideration when looking at the two above approaches.

Have a good, two-way conversation with your plastic surgeon and together you will find the right combination and right approach for your new procedure!

Dr. Donald Brown
Plastic & Reconstructive Surgeon
San Francisco, CA
www.DrDonaldBrown.com