Should I get my implants over or under muscle? I am recieving conflicting opinions from plastic surgeons.
What's Better - over Muscle or Under Muscle Implants?
Doctor Answers 23
For flat breasts, breast implants work best under the muscle.
1) We individualize based on the anatomy. For relatively flat breasts with no excess skin (like yours), I think under the muscle is better (more of your own tissue covering the implants).
2) When you are trying to correct some sagging with implants, then over the muscle generally better (implants fill skin envelope better if they are over the muscle).
3) For body builders, always over the muscle.
Breast implant placement
There are various factors regarding how you want your breasts to look and feel, but if you and your doctor have a good, open line of communication, you shouldn’t need to go back and forth on your decision. A major factor that effects how breast implants look and feel is whether they're inserted over or under the chest (pectoral) muscle. I do submammary and submuscular implants, inserting the implants under the breast tissue and over the muscle through an incision in the breast fold. The result is fabulous: perkiness with barely a trace of scar.
If you want the most natural-looking breast you'll need a subpectoral implant, in which the implant is placed under the muscle. This procedure also requires the merest incision - about three centimeters in the crease under the breast or at the edge of the nipple -- and diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant which occurs in 10 to 30 percent of cases.
In short, you must know -- realistically -- what you are starting with, as well as what you want to look like when surgery is done. Do you want a natural appearance or a round, perky look? These are some of the factors I weigh with my patients when evaluating what type of procedure to do.
Under or over
The implant is placed over the chest muscle, under only the breast tissue.
- good for women with more of their own natural breast tissue so the implant can be hidden better. Also good for tuberous breasts.
SUB-PECTORAL POCKET - Dual Plane (under the muscle) - more common
The top part of the implant is placed under the chest muscle and the bottom third is covered by breast tissue.
-creates a natural teardrop shape. The implant is better covered so it's better for women with less of their own breast tissue. Makes mammograms easier to read.
Talk to the surgeon you feel most comfortable with about these options.
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Below the muscle implants are better
Because the look is better, the feel is better, the mammograms are better, and because there may be less capsular contracture, I always go under the muscle.
Implants above or below the pectoralis muscle
I am in agreement with the four answers already given. Short term and long term the experience and consensus his clearly on getting the implant under the pectoralis muscle at least for the upper half (pole) of the breast. To vary from this experience is asking for a less ideal result both short term and definitely long term. I'm not convinced that the risk of capsule contracture is less but there are plenty of other reasons to pad, protect, and blend in the implant using the pectoralis muscle. The only real downside or trade-off is the increased animation of the breast when flexing the pec muscle postoperatively which can be minimized by a dual-plane release of the muscle.
If the implant is placed above the muscle it should be a gel-filled implant and the patient will have to accept potential visibility of the implant over the long term. It is not clear to most US plastic surgeons whether the 4th generation gel implants (cohesive or gummy-bear implants) will change this. I tend to doubt it.
What's Better - over Muscle or Under Muscle Implants?
Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.
Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.
Hope that this helps! Best wishes for a wonderful result!
Different opinions on this one
personally, i place almost all of my implants under the muscle. this is usually done in a "dual plane" fashion, meaning, the upper 1/2 of the implant is covered by the pectoralis muscle, while the bottom of the implant is covered by the gland.
the main motivation for this is to help to camouflage the upper pole of the implant. a simple look at your picture shows that your ribs are quite visible. you do not have much soft tissue in this area, and using the pec to help cover the implants will help to soften the edges of the implant, and therefore camouflage the implants.
some surgeons who are older than i am, practiced in the era of subglandular implant placement. my feeling is that the trend has definitely moved to submuscular placement of the implants. that is where i would place your implants if i were doing the surgery.
Location of Breast Implants
Breast Implants - Above or Below the Muscle?
The next very compelling reason to select sub-pectoral placement is a cosmetic one. Implants placed on top of the pec major tend to stand out in the upper pole of the breast, creating a rounded, convex and distinctly unnatural-appearing breast profile. With implants in a sub-pectoral position, the upper pole of the implant is flattened somewhat by the muscle, helping to create a smooth transition from the area in the upper chest where the breast begins, and a gradual slope towards the nipple that is not excessively rounded or convex. In some patients with a fuller breast volume preoperatively one may get an acceptable appearance with pre-pectoral placement - initially. The problem is that as breasts age, the fatty tissue atrophies and breast tissue thins out, and the area where this is most obvious is in the upper pole and cleavage area. So a pre-pectoral implant that was initially well-concealed may, after a few years, become painfully obvious (including visible implant folds and ripples) in the upper pole.
'Under the muscle' and 'sub-pectoral' are actually somewhat misleading terms, as in most cases the implant is only partially subpectoral. The anatomy of the pectoralis major muscle is such that it is actually just the upper/medial half of the implant that is covered by the muscle, while the lower/lateral half of the implant is submammary. The pectoralis major thus provides an additional layer of tissue to conceal the implant in the most cosmetically significant area of the breast: the cleavage area. This is why saline implants are often easy to feel laterally, as they are covered by breast tissue only in lateral aspect of the breast, and in slender patients who have small breasts preoperatively the implant is often immediately under the skin in this area.
Choose the "plane" which is optimal for your situation.
Based on the photo submitted, I concur that the optimal position would be "dual plane": under the pectoralis major muscle in the superior portion and below the breast tissue in the lower pole. This plane confers the following advantages: a) better superior pole (area between collar bones and nipples) soft tissue coverage, as the pec muscle drapes over the upper part of the implant; b) lower rate of capsular contracture (scar formation around the implant); c) superior imaging by mammography. Dr. Placik has astutely pointed out that the differences between your breasts will provide more challenge for your implanting surgeon than deciding on the best plane.
Some women are better served by subglandular (over the muscle positioning) a) those who have adequate upper pole coverage, typically >2cm by pinch; b) those with a "tubular" breast, which is a constricted base with sparse breast tissue under an overly enlarged nipple-areolar complex; c) body builders whose customary chest flexing poses typically cause lateralization of the breast implants. Hope this helps.