Breast Implants Over the Muscle—The Pros and Cons

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Basically, breast implants are positioned under or over the muscle. There are some slight variations of these two, although they are the fundamentals of placement technique.

Breast implants over the muscle, or subglandular, has received some notoriety due to its less than optimal cosmetic results. Because only the glandular tissue, breast fat and skin cover the implants, small breasted women will have an increased risk of rippling, scalloping, and palpability.

Nevertheless, for the “right” candidates who understand the ramifications of subglandular breast implant placement, the technique can still deliver impressive results.

The first step to achieve good results from this implant placement is to have a decent amount of breast tissue prior to surgery. The idea is to have a thick coverage to prevent rippling, or unwanted waviness on the top surface of the implant; and scalloping, or undulation around the prosthesis’ edges.

Meanwhile, the “anatomical” contraindications to this implant placement include small breasts and low body fat percentage commonly seen in athletic and naturally thin women.

For patients with sufficient “coverage” who want a somewhat rounded look rather than a more teardrop shape, the subglandular technique could also help them achieve their cosmetic goals.

Aside from having enough breast tissue, another way to minimize the risk of scalloping, rippling, and palpability is to use silicone breast implants whose cohesive gel filler acts almost like the natural tissue.

The latest version of silicone implants, or more commonly referred to as gummy bear implants, are believed to further minimize the risk of rippling and other similar cosmetic problems because of their form-stable structure.

Being form-stable due to their molecular structure that has a strong cross-linking, gummy bear implants are able to reduce the incidence of waviness. But because these have a textured outer shell, there still some risk of traction rippling of the skin.

Saline implants which are filled by sterile saltwater solution, meanwhile, are generally not a good choice if the prostheses are going to be positioned over the muscle due to the increased risk of rippling and palpability. The risk is further aggravated if one has little tissue coverage.

As of this writing, it might be safe to surmise that most breast augmentation surgeries are performed with the submuscular technique in which the implant’s upper half is placed beneath the strong, thick pec muscle.

Aside from the additional coverage, the submuscular implant placement also interferes less with breast imaging exams.
Article by
Beverly Hills Plastic Surgeon