What is it that Doctors do to the pectorial muscle when placing an plant behind the muscle ?

I keep reading that pectoral muscle needs to be released at time of breast implant surgery . What does this mean ? Are they cut and placed elsewhere or moved or other ? If this is not done is that what causes the pectoral muscle to indent into the breast creating deformity ?

Doctor Answers 7

Pectoral Muscle Implants

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The inferior portion of the pectoral muscle is cut away (released) from the rib cage to form a pocket for the placement of the implant. You want to place the implant under the muscle in order to (a) camouflage the implant, (b) the pectoral muscle forms a muscular bra to hold the implant in place and (c) there is less capsular contracture in sub muscular placement which is one of the most common major complications+ of breast augmentations. Capsular contracture requires surgery to remove the scar tissue.

Your question as to what causes the pectoral muscle to indent and create deformity is a good question. The deformity occurs when the pectoral muscle is cut or divided along the cleavage line. This is very difficult to correct when it occurs.

Philadelphia Plastic Surgeon

Pectoral muscle incision for sub-muscular breast augmentation

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The pectoralis muscle is actually incised and detached from the rib from the level of your breast bone out to about the mid nipple position and most cases.  This is left open to allow the implant to descend or drop into the proper position beneath your breast.  When you see the pectoralis contraction deformity and means that the incision is too wide for the implant has bulged through the incision in the muscle.

Submuscular pocket dissection

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This is a good question.  The implant goes behind the pectoralis muscle.  Most of the space behind the muscle is only loosely attached to the underlying pectoralis minor muscle.  There are areas where the muscle must be released, from the 7:00 to the 5:00 level.  This helps with positioning of the implant.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

What is it that Doctors do to the pectorial muscle when placing an plant behind the muscle ?

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Good question but to give a thorough description of surgical technique in the limited space allowed here is not possible. Best to get a consultation for questions like that.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

What is it that Doctors do to the pectorial muscle when placing an plant behind the muscle ?

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Thank you for the question.

Most plastic surgeons performing breast augmentation surgery today place breast implants in the  partially sub muscular position (dual plane).  "Dual plane" breast augmentation refers to the technique where breast implants are placed under the muscle superiorly and in the sub glandular  position inferiorly.  I think this is the best way to go for most patients. On the one hand, patients benefit from the sub muscular position  with increased tissue coverage of the breast implant, less chance of encapsulation, less potential for rippling/palpability of the implants and less interference with mammography.  on the other hand, the breast implants tend to “save” more naturally in the patient's breast skin envelope and hopefully is associated with a lesser chance of animation or flexion deformity ( movement/distortion of the breast implant with flexion of the pectoralis major muscle). You will find much more information about breast implant positioning on this website as well as on the attached link. Best wishes.

No direct damage is done to the pectoralis muscle with sub muscular placement of breast implant.

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The bottom border of the pectoralis muscle is incised in the pectoralis muscle was lifted off the chest wall. The origin near the bottom of the sternum is partially released to prevent thumb printing. Once healed the pectoralis muscle should have normal function.

Over Vs. Under the Muscle

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Thank you for your inquiry on breast augmentation.

This is a very common question and also very important for you to consider when planning a breast augmentation.
  • The breast sits on top of the pectoral muscle, the main muscle of the chest that goes from the shoulder to the sternum (breast bone). It is a muscle that moves the shoulder.
  • An implant can be placed behind the breast so it lies on top of the pectoral muscle.
  • Or it can be placed under the pectoral muscle, so it lies over the ribs.
  • Implants placed over the muscle hurt less after surgery, look more natural but are more prone to form capsules (hardening).
  • For this reason, the trend today is to place implants under the muscle.
However with the new Sientra highly cohesive gel implants, the trend is reversing. The risk of capsules is still higher with these implants when over the muscle but research suggests capsules do not form in 96% of these implants.

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.