Under the muscle or over? (photos)

It can be confusing and frustrating for patients when doctors have different opinions about matters like when to place breast implants over versus under the muscle. The advantages of over the muscle implants are as follows:       --more upper pole fullness (not less) and more medial fullness (cleavage);       --a higher, perkier result;       (I disagree with your physician's statement that over the muscle implants have more upper pole fullness; I think most plastic surgeons feel the opposite is true).        --probably lower capsular contracture rate;       --better soft tissue support (less droop) over time;       --less rippling.Over the muscle implants will have a lower position which some doctors do consider more natural, but the implants, in my opinion, look lower, heavier (more droopy), and may have more rippling. Some physicians will place implants over the muscle in weight lifters or body builders because under the muscle implants can move up with strong pectoralis muscle flexion. But body builders are more prone to rippling as they loose body fat, so under the muscle will usually look more natural. I have several patients who have won competitions with under the muscle implants.Some physicians will place implants over the muscle when patients have mild droop. My observation is that the droop generally worsens due to the poorly supported weight of the implants when placed on top of the muscle. To reiterate, it can be frustrating to get different opinions from different doctors, but I think the advantages of the subpectoral plane strongly favor it versus the subglandular plane. Thanks for your questions. Good luck.    

I think you can still achieve upper breast fullness with high profile implants under the muscle. You would also have the advantage of more natural looking cleavage, better future mammograms and a decreased risk of developing a capsular contracture. Good luck!

The pocket placement, the choice of implant style, implant size, breast volume, muscle thickness all play a factor in creating the perfect shaped breast to match your individual goals.  Some surgeons consider all those factors, some just pop them in and you get what you get.  Generally speaking though the muscle coverage will diminish the full round upper pole appearance somewhat.Dr Rodger ShorttOakville Plastic SurgeonDirector of Cosmetic Surgery Training Program &Assistant Clinical Professor,McMaster University

Hi Michelle. It is true that implants placed on top of the muscle are more likely to deliver a round and full upper pole. However, implant placement is not the only key factor. Selecting an implant with a high profile (the amount it projects form the chest wall) will also produce upper pole fullness even when placed under the muscle. There are other considerations when choosing pocket placement and only a full discussion during the consultation will guide you in the right direction. Good luck!

I appreciate
your question.



The best way
to determine implant size is based on chest wall measurements that fit your
body. Once we determine that we can choose the profile based on what you
want or need to achieve.



Implants
under the muscle, there is less risk of capsular contracture. Anatomic
implants tend to give a more natural shape with more nipple projection.



The best way
to assess and give true advice would be an in-person exam. Please see a
board-certified plastic surgeon that specializes in aesthetic and restorative
breast surgery.



Best of luck!



Dr. Schwartz

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery and recovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Good upper pole fullness can be achieved with implants under the muscle.  This really depends on the size and projection of the implant and your anatomy.

Going under or over the muscle depends upon your anatomy and what type and size of implant is used. For most saline implants, I recommend going behind the muscle to minimize the risk of rippling. Usually, placing the implant behind the muscle will give nice upper breast fullness. I would suggest going back to your surgeon and discussing this again with him.

Thank you for the question and the breasts may look rounder in the upper pole if implants are placed in front of the muscle but there are far more variables that need to be taken into consideration when deciding whether to go infront or behind the muscle.  So get opinions after an examination from experts in your area to see what might be best for you.Dr. Corbin

Under the muscle breast implants are likely to create more upper pole fullness than implants on top of the muscle. This difference may disappear with time.