Johnny Franco, MD, FACS

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

One of the most common questions I get during a breast augmentation consultation is whether a patient can avoid doing a lift if they just get a larger implant. This is a difficult question as it depends on the specific situation, however there are several guidelines. First of all, if you need a breast lift then you need a breast lift. Often patients will use a much larger breast implant for their breast augmentation then they wanted to avoid doing a lift and the result is a large saggy breast. The size of the implant can be taken into consideration when determining the type of lift that is being performed. The breast implant can be combined with a peri-areolar lift, vertical or full (anchor) lift. In certain situations you may be able to decrease the scaring needed from the lift when adding an implant. A good discussion for another time! The biggest determination if an implant can be used instead of a breast lift is the amount of ptosis and asymmetry the breasts have on the specific patient. A breast implant at most can lift the breast about an inch. I truly believe wish pictures are priceless when discussing your aesthetic goals with your plastic surgeon. For patients that are on the fence if they need a lift, it can be helpful to your plastic surgeon to know your goals so that they can help guide you to a result you are going to love for years to come. Often when I see a patients wish pictures it is obvious which procedure is going to help them achieve the result they desire. If patients are truly anxious about doing a breast lift, they can do the breast augmentation, let the breast settle for three months and then decide if they want to perform the breast lift. Plastic surgeons try to guide patients to avoid patients having to come back several months later because they are unhappy with the results of their breast surgery. Please discuss your breast augmentation options with your Board-Certified Plastic Surgeon.