Teardrop implants: under the muscle?

Several of the most important reasons to go behind the muscle are to add tissue to mask rippling and to blend the edges of the implants so that they are less conspicuous.Since teardrop implants (specifically the Allergan 410) rarely ripple, and since their tapered edges blend well into the natural breast surrounding the implant, it seemed logical to conclude that they would do well in front of the muscle.The implant was first used in Sweden in 1993 and most of the first cases were in front of the muscle.  Rippling was not an issue.  Early results were great.  But after a year or two they were noticing that the tissue over the implant was thinning from the pressure of the implant and that the edges were gradually becoming more obvious.For that reason they soon switched to behind the muscle and that is the standard way that it has been taught since US clinical trials began in 2001.  I've done thousands of these over these past 15 years and with few exceptions have placed them behind the muscle.The purported disadvantages of going behind the muscle are illusory: there is not any more pain, cleavage can be created, and any amount of fullness in the upper breast is possible.  The only notable trade-off is that when you contract your pectorals muscles you will see some movement of the implant and even some traction on the skin in the lower inner breast in thin patients.  You need to be aware of this, but it is well worth the tradeoff in most situations.More specifically the current way to place implants behind the muscle is "dual-plane."  That means the surgeon decides exactly where and how much muscle coverage will best suit a particular patient and precisely performs the surgery to control the muscle in that position. "Half over/half under" are commonly used misnomers and have no basis in anatomy.

Teardrop breast implants can be placed both above and below the muscle with very natural results. Your plastic surgeon may have recommended submuscular placement based on his experience working with shaped implants and his evaluation of your natural breast tissue. What’s more important than placement in preventing rotation, though, is your plastic surgeon’s skill in creating a pocket for the implants that isn’t too large. Although rotation is rare, you want the implants to fit snugly in the pocket without enough room to rotate. You may also want to talk to your plastic surgeon about low profile round implants that can give you a natural look without the risk of rotation.

Regardless of the shape of the implants, most surgeons recommend placing them under the muscle. There are some anatomic advantages to placing these above the muscle in isolated patients. This is something that should be discussed with your surgeon during a consultation. To determine the ideal location would first require a through physical examination of the breast, muscle, and chest wall. 

Hello,Despite the overwhelming negative sentiment of most of my colleagues, these implants have a lower overall complication rate compared to round smooth implants.  Fears of implant rotation are overblown, and your risk in the hands of an expert are 2%. These implants can be placed above or below the muscle, but what is right for you should be discussed with your surgeon. Dr. Singer does a nice job summarizing.Best of luck!

Hi. The short answer is that both round and anatomic implants can be placed either in front of the muscle or in a dual plane (partially beneath the muscle). The decision to use one or the other pocket depends on the soft tissue cover of the individual patient - essentially the thinner you are and less breast tissue you have, the more likely one is to suggest a dual plane placement. This is true for either round or anatomic shaped implants. Each surgeon may have a particular bias towards the use (or not) of shaped implants. My own opinion, is that if one is using a dual plane placement in an "average" breast augmentation patient, there is little or no difference in the outcome between using shaped (anatomic) implants or round implants and so my preference is to use rounds in the dual plane position in the overwhelming majority of primary breast augmentation patients, and there are good studies to support this view.