The vast majority of implants placed today are beneath the muscle in a "dual plane," or partial muscle coverage, fashion. Sometimes other methods may be appropriate based on previous breast surgery or specific deformities that the surgeon is trying to correct. No one method is right for every patient, so make sure you understand your options when you meet with your surgeon.
In my opinion implants can go two places that are functional and used today. That's above the muscle which which is actually subglandular. They are one and the same. The other position is below the muscle partially this is also known as a dual plane. Placing the implant totally below the muscle is no longer a technique of choice.
Implants are generally placed above or below the pectoralis muscle. There are some variations but the fundamental difference is the implants relationship to this chest wall muscle.
There are several different positionings for a breast implant
- Dual Plane
Each has there own set of risks and benefits. Your plastic surgeon will assist you in determining which will be best for your particular anatomy.
Classically, there were two defined positions (above or below the muscle).
1.The above the muscle implants were placed over the pectoralis major muscle and under the breast tissue (sub-glandular).
2. The under the muscle implants were placed under the pectoralis, and above the rib cage. Since the pectoralis muscle only reaches down to about the level of the nipple as it courses from the breast bone to the shoulder, the lower part of the implant is in the same plane as the over the muscle implants, hence "dual plane." By some definitions, dual plane is defined by additional separation of the the pectoral muscle from the breast tissue to allow some upward mobility of the breast tissue.
3. Dual plane, defined above.
4. Sub fascial--above the muscle fibers, but under the breast tissue and the lining of pectoral muscle. This has some of the advantages of each of the other alternatives.
By-in-large, most surgeons note fewer capsular contractures with implants under the muscle, but more animation issues (implant distortion with arm movement).
Hope that helps.
Technically there are 3 placements available for breast implants, but only 2 are widely used. Subpectoral - or completely under the muscle - is very rarely used anymore. It has been largely replaced with the dual plane approach. Using this method, your plastic surgeon loosens the bottom portion of the pectoralis (chest) muscle and places the implant underneath. This method allows the implant to "settle" a little giving a more natural look than implants placed completely under the muscle. This is the most common placement I use in my Atlanta area surgery center. Covering the implant with muscle tissue masks the implant to some degree. Another option is the subglandular, or above the muscle, approach. I place implants above the muscle in body builders since they often do not want me to manipulate the muscle and in women with breast sagging who have declined to have a breast lift. There are benefits and downsides to either approach. I like dual plane because the implant is mostly under the muscle. This helps avoid visible rippling and helps the implant feel more natural to the touch. Placing the implant above the muscle (subglandular) helps avoid a double bubble - although the best way to avoid this is to have a breast lift if your surgeon recommends one. A "double bubble" occurs when the breast implant sits in great position under the muscle and your natural breast tissue sags below it. The best way to know which breast reshaping procedure(s) is/are right for you is to meet with a board certified plastic surgeon.