Should Implants Be Placed Under or over the Muscle for a Slim Frame?

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and hide rippling of the implant. Implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture).  Also, breast cancer screening with mammography gives better images of breast tissue when implants are placed under the muscle. Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

If there is thin skin and soft tissue, it is best to place implants in the submuscular plane. The more soft tissue between the implant and the outside world, the better the result. There will be less visibility of the implant edges, less chance of rippling, and a more aesthetic contour i the upper portion of the breast. If the nipple position is above or slightly below the fold of the breast this is the best approach.

If you are very thin, then you are better off having as much soft tissue coverage as possible. The muscle adds another layer especially in the upper pole.

If you have thin tissue coverage, then the best placement for the breast implant is under the chest muscle. It provides more coverage, better shape, better for mammograms and has been documented to have lower capsular contracture rate. The implants will move when you flex the chest muscle so patients who are body builders may have concerns about that but otherwise most patients who are thin will do better with under the muscle placement.

I generally prefer to place the implant under the muscle especially with a thin patient. There are many options in breast augmentation. Educate yourself about the different choices. The more soft over the implant the more natural the result. If you are thin and you place the implant above the muscle any degree of capsular contracture wiill give you a very rounded, implanted appearance. If your goal is a more natural result then below the muscle may be the best approach.