How to Decide Wheather to Have the Implant Under the Muscle or on Top?
Doctor Answers (9)
I usually place implants under the muscle because I find that most of my patients are very thin and could use the extra soft tissue coveragge in the superior pole.
Implants over or under the muscle
This is a hotly debated question and there is no right or wrong answer. Clearly, the vast majority of surgeons prefer to place implants under the muscle but I would discuss the pros and cons of your particular circumstances with your surgeon.
I prefer to put breast implants under the muscle
There is not one correct answer but i personally prefer to almost always put the implants below the muscle since they are less palpable, they look more natural, you get a better mammogram and there are less likely to develop hard capsules.
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It is best to "err" on having your Breast Implants placed UNDER the muscle
Because ALL breast implant RIPPLE and PLEAT, only a few people with a fair amount of breast tissue already available can adequately cover the implants and hide these imperfections. The BEST way to produce a great breast Augmentation result is to find an implant that fits a woman's chest wall AND is covered by her present breast tissue.
Since the vast majority of women seeking breast Augmentation do NOT have a lot of breast tissue cover, we prefer to place breast implants UNDER the Pectoralis Major muscle which lies under the breast gland. This way, the top 1/3 of the implant (the part most likely to show ripples when standing) is covered by the muscle and existing breast gland. As a result, the overwhelming majority of breast Augmentations in the US are done UNDER the muscle.
Under vs. Over the muscle
My preference is under the muscle. This is more painful, but tends to give the best long term result with less chance of contracture, ripples, visibility, more protection, less chance of bottoming out. Others may have other reasons for over.
PLACEMENT OF BREAST IMPLANT ABOVE OR BELOW THE MUSCLE
This is one of those "grey" areas of plastic surgery and different opinions are the norm.
However, given that 1 out of 7 females in this country develop breast cancer in their life time, I always place the implant under the muscle, since it allows better visualization of breast tissue during mammography.
Breast Augmenation: Over or under the muscle
If you want the most natural-looking breast, you will need a subpectoral implant, in which the implant is placed under the muscle. This procedure requires the merest incision—about three centimeters in the crease under the breast or at the edge of the nipple—and diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant, which occurs in 10 to 30% of cases.
Once the incision is made, the surgeon creates a pocket into which the implant is inserted, which in your case, would be located beneath the pectoral muscle underlying the breast tissue. Subpectoral implants aren’t right for everyone, though. If you have saggy breasts, an implant placed under the muscle won’t fill out that empty breast sack, and you’ll get what we call the “double bubble” look, where the breast hangs several inches below the implant.
Subglandular vs Submuscular vs Dual-Plane Breast Augmentation
This is one of the debates that rages on in the plastic surgery community, with surgeons on both sides of the fence. However, more and more surgeons prefer the partial submuscular, or dual-plane approach these days. It really is a misnomer that the implant is completely under muscle. In reality, only part of the implant is under the muscle ( usually the top 2/3 to 3/4), which is why some people prefer the term dual-plane. Going on top of the muscle makes the recovery a little quicker, and allows the implant to settle faster, but if you are thin, then the chance of seeing the implant or feeling the implant are higher. The rate of capsular contracture is also higher above the muscle. When you go below the muscle, recovery is a little more painful the first few days, but not any longer in terms of length of time. The muscle can help mask the implant to a degree, as well as keep the rates of contracture lower. The muscle still works completely normal, but some women can flex their muscle over the implant, leading to a temporary shift of the breast under extreme muscle flexion. It can look a little odd at first, but does get better with time. There is a myth that on top of the muscle looks more fake, or more real, etc. They are all myths - either way can look natural or more "fake", depending on the type and size of the implant used. I hope this helps.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.