Under or over the muscle? Booked in next week for 295cc anatomical implants. Age 27. (Photos)

If you are having surgery next week your surgeon should have explained why he is recommending this. If you are not sure, you should see your surgeon asap and clarify.
Regards, Dr Steve Merten, Sydney

Submuscular implants have more soft tissue coverage and a more natural look.  You appear to be an excellent candidate for a form stable anatomic implant.

Hello and thank you for your question. There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.  This entire surgery can be performed with a
small incision technique.  Make sure you specifically look at before
and after pictures of real patients who have had this surgery performed by your
surgeon and evaluate their results.   The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Thanks for your question. It is difficult to make a judgement on pictures alone but from what I can tell, there appears to be minimal breast tissue on the upper pole of your breast and I would thus suggest you would benefit from placing the implants under the muscle. I feel this will also aid in giving you a natural look. All the best!

I prefer under the pectoralis muscle augmentation in the proper candidates. Muscle shape can influence the decision. If your pectoralis muscle is short and tight it is better to go above the muscle. Discuss this with your plastic surgeon. Good luck....

I think you will be fine both above or under the muscle. I love anatomic textured implants, but use them less in my practice due to the association with anaplastic large cell lymphoma. Although the risk is very small, when I tell patients about it they almost always choose smooth implants. Make sure you are well informed about your implant technique and choice. Good luck.

Dear libertypink,I almost always place implants submuscular. 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

I prefer under the muscle for most of my cases and especially for anatomical breast implants. However, there’s no way to second guess your surgeon who has actually examined you. There will be less pain above the muscle. Good luck. Dr. Aldo

I think the primary advantages of being in front of the muscle is are a decreased recovery time and no risk of an animation deformity when flexing your chest muscles. I think the primary advantages of going behind the muscle are the decreased risk of forming a capsule and a better mammogram in the future. I would discuss this further with your plastic surgeon. Good luck!

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.
 Subglandular Augmentation (“overs”): 
Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also fasterSubglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling when compared to subpectoral augmentation.Subglandular implants can also create the illusion of improved cleavage by preferential over-dissection of the central/medial pocket allowing the implants to be forced more to the midline. There is no limiting muscle as there is in a submuscular augmentation. 
Subpectoral Augmentation/Sub-muscular (“unders”): 
Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.Subpectoral implants have a lower rate of capsular contracture.Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.One of the more commonly noted differences is one of "shape." As described above the pressure of the muscle overlying the upper pole of the device in a submuscular augmentation contributes to a more gradual incline as opposed to the rounding noted in subglandular augmentation. This is not necessarily an issue of size but rather projection. Some will argue submuscular is more natural (and for the vast majority of patients this may be true) but ultimately this is a question of anatomy and expectations. Some patients are seeking an augmented look with upper pole fullness and rounding while others are seeking subtlety.As always, discuss your concerns with a board certified plastic surgeon (ABPS).