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Is an "Under the Muscle" Breast Implant Truly Under the Muscle?

asked 2 years ago by 6106anon in Ohio
Latest answer by Armando Soto, MD
Question viewed 929 times
Tags: under muscle

I was told by a plastic surgeon that an under the muscle implant is not truly under the muscle. This is very misleading. I know there are overs and unders and partial unders. Do you have to specify to a doc that you want complete unders?

18 answers to Is an "Under the Muscle" Breast Implant Truly Under the Muscle?

"Under the Muscle" Implants Are Only Partially Covered

As already stated, the pectoralis (or chest) muscle only covers the top half of the implant. The muscle's bottom half usually only reaches down to about the level of the nipple. Even partial, or "dual plane" coverage of the implant by the muscle offers benefits. There is definately less of an edge visible with the implant, giving it a more natural shape at the top. There is also less capsular contracture using this technique, and mammography is usually easier....

John LoMonaco, MD
Houston Plastic Surgeon

www.DrLoMonaco.com

How much muscle coverage is there in "under the muscle" breast augmentation

Hi there- The amount of coverage of the implant will depend on the surgeon you choose, their preferences, and experience. I would caution you that excessive muscle coverage will provide you with virtually no benefit, and does inevitably lead to poor long term outcomes. Also, as I have said on this site many times, it is NOT in your best interests to micro-manage the technique of the surgery. Truly some of the very worst outcomes I have seen in patients after they had... more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Position of Breast Implants

Implants are either placed above the muscle (subglandular placement) or under the muscle (submuscular). The the muscle is raised, it is oven divided inferiorly (near your inframammary fold) to accommodate the size of the implant and to ensure anatomic contour. Sometimes, the surgeon sews a piece Alloderm (dermal matrix) between the cut muscle edge and the chest wall to complete the coverage. However, this is normally only done in patients with very thin tissue or in reconstructive cases... more

David Shafer, MD
New York Plastic Surgeon

Submuscular Breast Augmentation

Not many implants are placed completely under the muscle. I would be careful what you ask for and that is a decision that is left up to your surgeon. Some patients benefit from being completely under the muscle, some need release of the muscle and some need dual plane. In my mind, there is no role for subglandular augmentation when a dual place can achieve the same result with less complications (capsular contracture).

Farbod Esmailian, MD
Orange County Plastic Surgeon

Under the muscle implants

The majority of "under the muscle" implants are not totally covered by muscle. Usually the msucle is divided along the lower pole to allow the implant to sit properly in the pocket. However, some surgeons do place them totally under the muscle, however, I find that they sit too high and often the breast tissue itself falls off over the implant. In cases like this, I have had to treat patients operated on by other surgeons( because I do not like that technique) and have had to... more

Steven Wallach, MD
Manhattan Plastic Surgeon

The Meaning of "Under THE Muscle" in Breast Implant Surgery

The vast majority of Breast Implants placed "under THE Muscle" these days are actually only partially covered by the muscle in question - The Pectoralis Major muscle. The triangular shaped muscle can physically only cover the top third to half of the implant while the rest of the lower half of the breast implant is covered by the breast tissue. This configuration and specifically the Dual Plane placement gives augmented breasts a natural appearance. On the other hand, the TOTAL... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Partial or total under the muscle (submuscular) coverage of implants with breast augmentation

Be careful what you ask for. Complete unders can be stiff and move very little. We tend to perform this only in breast reconstruction and even then it is slowly becoming replaced by partial unders with biologic dermal slings to support the lower half and create a softer more supple breast. Some surgeons claim they perform a complete submuscular pcoket when in reality they are really placing it under the fascia in the lower outer portions of the breast.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

"Under the muscle" breast implant truly under the muscle

Dr Rand bests describes this issue in his previous posting. Yes it is a misleading way to describe a surgical technique, but the implant does have pectoralis major coverage in over 50% of its surface area of the implant. COMPLETE muscular coverage is possible but it would add weeks to recover and complications. With over a million sub muscular implants in place you should trust your PS to do the "standard of care" in your implantation. From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon

"under the muscle implant" is really only partially under the muscle

When we place a breast implant in what is called the subpectoral plane, we are lifting the pectoralis major muscle to put the implant underneath. The pectoralis is a large, triangular muscle that runs from the breast bone up to the upper arm. At the breast bone, it is wide and runs along most of the breast bone length. At the arm, it has narrowed to a band of about an inch in diameter. Because of the shape of the muscle, only the upper portion of a breast implant will be covered by the... more

Elizabeth Lee, MD
Bay Area Plastic Surgeon

Let plastic surgeon decide where to put breast implants.

Hi. 1) This is a very technical issue. You need to trust your surgeon to do meticulous planning before your operation, based on your anatomy and the exact look you want (show the surgeon pictures). 2) It is part of his or her job to pick the right size and shape breast implants, and to choose the best plane to put them in. "Under the muscle" usually means that the top half of the implant is covered with muscle. Under the muscle is not the best location for many women. You... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Defining terms with under muscle breast implants

I don't think your plastic surgeon intended to be misleading, but because of the anatomy of the muscles behind the breast it is important to understand what the terms mean. The pectoral muscle which covers most of the implant is shaped like a Japanese fan, with the handle end connected to the top of the arm; this creates the fold in the front of the armpit. The thin edge attaches to the breast bone and the ribs. Importantly, the muscle cannot cover the outer side of the breast. It also... more

Richard Baxter, MD
Seattle Plastic Surgeon

Sub-Muscular Breast Implant Placement

Sub-Muscular Breast Implants for Augmentation are never totally under the muscle. Placing a Breast Implant totally under the muscle is very difficult, even for reconstruction, about the only reason plastic surgeons will attempt to do so. We have essentially eliminated this option for other methods in reconstruction. There have been attempts to place augmentation implants under the fascia (the covering of the muscle) but I find no benefit. In fact, with the newer implants that can reduce the... more

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Subpectoral breast implants aren't totally submuscular

Total submuscular implant coverage really only applies in breast cancer reconstruction. In breast augmentation, a subpectoral implant is really a partially submuscular implant. This is sometimes called "dual plane" by doctors who want to make it sound as though they have some new magic on implant positioning. Submuscular positioning is preferred to subglandualr implants in most cases in my opinion.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Submuscular implants are only partially covered

There is no such thing as 'total sub muscular coverage' of a breast implant when placed in the standard fashion for breast implant surgery. One would have to elevate a serratus muscle flap and approximate it to the inferior pectoral edge for complete sub muscular coverage. What really is going on for sub-pectoral augmentation is that the implant is mostly covered by the pectoralis major muscle. The lower 1/3 is covered by breast tissue. If the inferior medial attachments of the pectoralis... more

Scott Sattler, MD
Bellevue Plastic Surgeon

Under the muscle

Under the muscle does not mean covered 100% by the muscle. The upper 2/3rds or so of the implant is covered by the muscle and the lower part is covered by skin and breast tissue. This gives a more natural look than 100% coverage would be.

Walter D. Gracia, MD
Arlington Plastic Surgeon

Meaning of Submuscular Implants

In my practice placing implants under the muscle means that they are placed under the muscle except for the most inferior portion of the implants which are indeed in a subcutaneous position. I inform my patients about this as I feel that it is impossible to obtain good result with an implant placed totally below the muscle.

John Whitt, MD
Louisville Plastic Surgeon

Breast implants REALLY totally under the muscle

Thanks for your question - Subpectoral (or under the muscle) breast augmentation is far and away the most common placement of implants for breast augmentation. The reason why is there are several benefits to implants being under the muscle. There is a lower rate of scar tissue formation around the implants The implants are more protected against infection. The implants are better hidden by the extra layer of tissue that comes from subpectoral implantation. However, many times the implant... more

Steven H. Williams, MD
San Francisco Plastic Surgeon

Submuscular breast implants

Submuscular implant are variously categorized. The subpectoral submuscular implants are only partial covered by the muscle since the muscle is a triangular-shaped muscle that does not mimic the surface area of the breast. The implant is only effectively covered by the muscle for approximately 25-50% of its surface area. Some implants will actually fall completely inferior to the lower edge of the muscle and not be covered at all. The total submuscular implant is covered by not only the... more