Is my opinion
the implants placed under the muscle tend to have a softer and more natural
look because the muscle drapes gently over the top of the implant. When
implants are placed above the muscle, particularly in the very thin patient the
result can look like a coconut stuck to the chest. There is also
clear evidence that capsular contracture rates and infection are lower
when implants are placed under the muscle and that mammography is better.
For my athletic patients, which is about 99% of my practice, when they go to
the gym and bench press or weight lift the implants will look less natural for
that moment in time because the pectoral muscle pushes on the implants.
But for the 97% of their lives, not bench pressing or weight lifting a
submuscular implant I believe he is a much more natural appearance. While
a woman with a fuller breast can sometimes hide a subglandular implant pretty
well, a subglandular implant can burn bridges for patients who might want a
breast lift in the future. A subglandular implant separates the breast
tissue from the muscle. If the patient wants a lift in the future the blood
supply to the nipple and the areola is more in jeopardy. Best wishes.
Smooth implants above the muscle may increase the risk. There are several factors to consider here with your surgeon.
Kenneth Hughes, MD
Los Angeles, CA
The answer to your question is not a simple one. It depends upon the type of implant used some of the data suggest higher rates of contracture and others suggest similar or lower rates. Also, some of the data people refer to is based on older studies using earlier generation implants that did have higher contracture rates.
The factor that is probably most related to the contracture rate of the implant is its ability to resist deformation. And that is likely related to the firmness of the filler (gel or saline) and the fill of the implant.
It can be hard to make a decision as to what is best especially if your surgeon is not dogmatic and presents you with options. But, it is not always that one way is better that the other but rather that there are trade offs and if you should have an undesirable outcome which one would be easier to correct or would you be happy to live with. I see patients that have contractures and are not bothered by it and do not even know they have it. The trade off of going under the muscle is an animation deformity.
My advice. Find a surgeon you trust, and have faith in. There are many choices to make and hopefully they can help guide you in to making the decision that is best for you.
Sub-muscular positioning of implants tends to produce less capsular contracture than supra-muscular placement.
That being said, there are those that cannot have implants placed under the muscle without concomitant mastopexy (breast lift) because the muscle and breast tissue do not lie at the same height on the chest wall.
In your case, since your consultants have said that either position will work for you, I would favor the sub- muscular position. A little more downtime for healing should really not be a consideration when a lifelong result is the goal. Only in body-builders with extremely thick pecs and professional athletes, where the muscle tension may be critical for swing and/or timing and strength, should one favor the supra-muscular procedure.
data suggests that capsular contracture may be higher with the implant placed in front of the muscle as you mentioned. Subfascial placement may be an option for you. You make this decision in consultation with your surgeon. If you are not sure, a third consultation may be of benefit.
are less when implants are under the muscle. There are also other strategies that could be employed such as the surface of the implant (smooth versus round), whether a funnel or other similar device is used, and the techniques employed by your surgeon as well as the incisions (least risk when incision under the breast). You have to take everything into consideration and make the best choice for you.
Yes, there are several studies that suggest that silicone implants above the muscle have a higher risk of capsular contracture.
Yes. There is an increase in capsular contracture in implants that are placed above the muscle. Also, I feel that placing implants submuscular (under the muscle) gives you a better longterm outcome.