When a breast implant is placed under the muscle is the muscle cut or ripped from your ribs to accommodate the implant?

Dear ErikaApril08,
I almost always place implants submuscular. Your muscles will be partially detached in order to make a pocket. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Breast implants under the muscle, in our opinion, is the safest method to lessen complications such as rippling and capsular contracture, while also providing the most natural looking results and is the preferred placement within our practice. Implants are placed behind the pectoralis major muscle, breast tissue, and glands while staying on top of the pectoralis minor muscle. This also adds an added layer of protection to the implant.The muscle is carefully divided with a cautery device, precisely at certain points and with a technique to minimize or eliminate any bleeding.

Some lower muscle is released to allow the implant to sit properly. The implants sit on top of the fascia that covers the ribs. I do not have women who do cross-fit or others things complain about weak muscles. However, I ask them to avoid such exercises for 2 months.

Typically during a breast augmentation that is placed under the muscle the pectoralis major muscle is detached at its inferior or lower border off the rib cage. This allows the surgeon to create the pocket where the implant will be placed. The implant is then placed under the muscle and above the rib cage. I do not anticipate you having any major deficits after your surgery however it may take some time to retrain your muscles and to regain the strength you had pre-op. Also something to keep in mind especially in very athletic patients is animation deformity. Basically when you flex your chest muscles, you may see the cut edge of the muscle and the implant bulge some on the bottom. You should try to do some research on this before your surgery and if you have any other questions or concerns contact your surgeon.

The majority of breast augmentations that I perform have the implants placed beneath the muscle. This helps to give support to the muscle, disguise some of the upper aspects of the implant, and provide a more natural look. A portion of the pectoralis muscle is lifted in order to create a space for the implant. You will be able to resume your active lifestyle once you have fully recovered from surgery.

Erika,
You are absolutely correct. Submuscular breast implant placement requires you to lift the pectoralis major (chest muscle) up and usually to release the bottom edge (cutting or tearing). There are several issues with this in physically active individuals.
First, there is a decrease in chest/arm strength for many months (8-12) while the chest wall heals. You will not be able to do push ups or pull ups and even difficulty turning hard door handles or open twist bottles. Although not permanent, it does last for quite some time.
Second: Animation artifact or defect (google it). When you flex your chest, the muscle and implant 'jump' in motion.
Best wishes.
Dr. Taranow

Hi and welcome to our forum!
During the procedure of submuscular breast augmentation, a relatively avascular plane is developed at the inferior portion of the pectoralis major muscle and a pocket is created to accept the implant. The muscle is not cut but instead is divided in the direction of its fibers at its lower margin, minimizing trauma to the muscle itself. The pectoralis minor muscle and anterior serratus muscles remain under the implant. The term "dissection" is preferred to "ripping" as it is performed delicately to prevent bleeding or muscle injury.
Muscular function / strength should not be altered by the procedure.
Best wishes...