Implants - Under the Muscle?

Do all implants go under the muscle? What's the difference if they don't?

Doctor Answers 8

Breast Implants Above or Under Pectoralis Muscle Placement?

Thank you for the question.

Although patients who have breast implants placed in the sub muscular ( or dual plane)  position may experience more discomfort during recovery, I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Ar breast implants always placed under the muscle?

No, sometimes they are placed under the breast tissue (between the muscle and breast). They are never placed within the breast gland itself.

Terms: Behind the muscle - subpectoral, submuscular

           In front of the muscle - subglandular, prepectoral

Plastic surgeons began placing the implants behind the muscle for two reasons:

1. To reduce visible wrinkles in the implants, particularly with saline implants and in thin patients.

2, To reduce encapsulation. Implants can encapsulate either in front or behind the muscle. Maybe there is a slight reduction in encapsulation behind the muscle. Statistics vary on this subject.

Advantages of implants in front of the muscle:

1. No distortion when the pectoralis muscle is flexed, called dynamic distortion. In the subpectoral position, flexing the pectoralis muscle flattens the implant at the top and can make it "jump." This can look strange, and this phenomenon doesn't exist when the implant is subglandular.

2. A more natural result when the patient has some sagging.

3. Generally, less discomfort in the post-operative period.

Disadvantages of subglandular (prepectoral) implants:

1. If encapsulation occurs, there may be more distortion and visible wrinkles unless the patient already has ample breast tissue.

2. Possibly slightly higher encapsulation rate.

Bottom line: Each patient has specific needs and this will dictate what your plastic surgeon's decision on implant position. Both positions are good but, as in most things, not perfect. In my practice anyone with minimal breast tissue or those who are very thin receive the subpectoral position. Athletes, on the other hand, usually get the subglandular position because excess use of the pectoral muscle seems to encourage encapsulation and weakens the pectoral muscle with subpectoral implants.

Hope this has helped you understand the pros and cons of the subpectoral and subglandular implant positions.




E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 78 reviews

Breast implants-under or over the muscle?

The answer depends on the patient's situation.  Under the muscle implant position started in an attempt to reduce the incidence of capsular contracture.  Some studies show that it does help reduce capsular contracture. In addition, more breast tissue is visualized on mammogram.  However not all the studies show reduced capsular contracture rates, the mammogram benefit does not translate into a health benefit for the patient and there are some potential disadvantages to placement under the muscle.   Another positive is that for patients who are very thin, the muscle provides additional tissue to cover the edges of the implant.  Potential disadvantages include dynamic distortion (movement of the implant with pectoralis muscle contraction) and a tendency of the implant to shift downward and outward over time.  For these reasons, the implant position is decided after examination of the patient and discussing the advantages and disadvantages with the patient.  For certain anatomic situations, such a tuberous breast or need for simultaneous mastopexy, I prefer subglandular implant position.  You will find that there is a range of opinions on this issue.  Hope this helps.

Tracy M. Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 27 reviews

Implant Positioning

Not all aimplants go under the muscle, some go on top of the muscle referred to as the pectoralis major. In some cases better breast projection can be achieved by putting the implant directly under the breast without the compression.

Scott Loessin, MD
Key West Plastic Surgeon
4.5 out of 5 stars 104 reviews


Not all implants go under the muscle it all depends on what the patients walks in with. If lets say your breasts are sagging and your not looking to getting a lift  then putting the implant over the muscle is the best bet for natural results. If you don't have a lot of breast tissue and don't need a lift under the muscle would be the best way to go about it. Hope you questions are answered.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 reviews

Above or below the muscle implant placement

Not all implants are placed in the submuscular position, this can be an individual choice.  It is important to understand the differences between the two locations.  Some breast shapes are more suited for subglandular or over the muscle positioning.  This can include the tuberous or constricted based breast.  Most research shows a lower incidence of capsular contracture with the submuscular placement of the implant but new research is showing some change in this line of thinking.  This question is best left to a discussion between you and your plastic surgeon

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast implants under the muscle

Breast implants may be placed either under the pectoral muscle or directly under the breast tissue.  There are advantages and disadvantages to each approach.

Breast implants placed under the muscle typically are better camouflaged, with the muscle smoothing the transition to the implant and making the implant edges less visible.  For this reason, very thin women or women with very little breast tissue tend to do better with an implant placed under the muscle.  Placement under the  muscle also helps to reduce the risk of a complication called capsular contracture, in which the scar capsule that normally surrounds the implant becomes firm and tight and may affect the feel and look of the implant.

Some surgeons feel that placement of breast implants under the breast tissue can create a more natural look, as the implants are affected by gravity much the same way natural breast tissue is.  Implant edges may be more visible and the implant may appear well defined, and some women do prefer this look. 

The selection of your implant placement will depend on your goals and preferences, and on your anatomic characteristics.  Please discuss all of your options with your board certified plastic surgeon.

All the best,

Dr. Skourtis


Mia E. Skourtis, MD
Portland Plastic Surgeon
5.0 out of 5 stars 1 review

Breast imlants location

Dear blonde,

   In 25 years of practice I have done them all under the Pectoralis muscle. In many 'Redos' I had converted the implants location from subglandular (under the breast or on top of the muscle) to sub muscular (under the muscle). Here are the reasons : 1. Less capsule contracture (hardening). 2. Less palpable implants, due to the thickness of the muscle that covers most of the  implants.

3. Mammogram is easier read for the radiologist when a muscle separates the implants from the breasts. 4. Less loss of sensation to the nipples since the nerves are on top of the muscle  , which is the plane of dissection in the subglandular pocket.

   There are some disadvantages like more discomfort in the first few days etc, but they do not overcome the above mentioned advantages.  Be sure to select an experienced board certified plastic surgeon.

                       Best of luck,

                                                      Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.