Do over the muscle placed implants feel natural? (photos)

Question

Hi, I have little breast tissue and wondering if over the muscle implants feel natural when compared to under?

Jed H. Horowitz, MD, FACS · Answer

Silicone implants are the preferred choice for over the muscle implant placement. However, there are different options available for over, under and dual placement of the implants depending on what is best for the individual patient:Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle.  The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.

Over the Muscle (sub-glandular) –  Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.

Dual-Plane - This placement method is a more current technique most often used when there is mild breast sag and the patient does not want a breast lift. The breast tissue and muscle are partially separated to allow the breast tissue to sit in a better position. Dual-plane can be discussed further during the consultation should breast sag be of concern.

Andrew L. Greensmith, MBChB, FRACS · Answer

no implant will feel 100 % natural so it is important for your doctor to examine you and advise you which method will give your the best result the bigger you decide to go with the implant the less natural

Martin Jugenburg, MD · Answer

Thank you for
your question.

I would first
like you to know that the decision to go
behind the muscle or over the muscle has to do with the amount of soft tissue
coverage – “padding” you have under the skin. Choosing a pocket that is tight
with sufficient soft tissue coverage not only prevents implant visibility,
palpability, and risks of excessive stretching on the breast, but also
excessive implant movement into the outer or inner sides of the breasts. A
hand-in-glove fit for the implant allows for a natural and long-lasting result.
Your surgeon will do a pinch test in the upper pole of the breast to see how
much “padding” you have. If you have less than 2 cm, then you do not have much
padding and it would be best to go under the muscle. Generally speaking, if
your ribs are visible under the muscle, then you do not have much “padding.” If
however, you have more than 2 cm of tissue, then you have the option to go over
the muscle or under the muscle.

Which pocket do you prefer?

OVER THE MUSCLE

If you are hoping to fully preserve the
functionality of the pectoralis major muscle due to athletics or body building,
or if you have a shapeless, constricted, tuberous, sagging breasts without
cleavage, then over the muscle may be a better option. Over the muscle
implant placement causes less trauma to the chest muscles, and the implants
will not be subjected to any pressure or injury due to muscle movement.The implant can
directly apply pressure on breast tissue to shape the breasts.However, over the
muscle implant placement may have higher risks of breast tissue wasting,
interference with mammography, and capsular contracture compared to under the
muscle placement.Higher risk of
implant visibility and palpability is possible if you are thin, and this can be
fixed used fat grafting where areas with less tissue coverage are filled with
your own fat to provide better contour and coverage.

UNDER THE MUSCLE

Under the muscle (partially submuscular)
is a preferred option for many surgeons because the muscle helps to maintain a
slope for the upper pole while allowing for a curvature in the lower pole,
while over the muscle will mostly make your breasts appear round and augmented.
In thin patients,
additional coverage by the muscle reduces the risk of implant visibility in the
upper and inner sides of the breasts. It also reduces risk of synmastia, and
provides less interference with mammography and breast imaging. It also brings
lower rates of capsular contracture.However, under the
muscle implant placement may allow the chest muscles to put pressure on the
implant distorting the breast shape and position in the long-term. You may
experience more pain following surgery due to the dissection of some muscle
attachments and you may lose strength while flexing your chest muscle and is
not suitable for athletes and body builders.

So which pocket allows a more natural
feel?

It truly depends on the amount of
soft-tissue coverage, the size of the implant, and the fill of the implant. If
there is sufficient soft-tissue coverage and the implant is adequately sized,
then there will be no implant palpability and visibility. Additionally, silicone
breast implants will provide a more natural feel compared to saline implants.

It
is important that you communicate your goals very clearly, but understand that
you need to have realistic expectations.

Hope
this helps, and best of luck!

G. Wesley Price, MD, FACS · Answer

Generally all implants for breast augmentation should be behind the pectoralis muscle ( actually the implants are behind muscle about 75%)_.  It was clearly shown many years ago that the under muscle placement leads to less capsular contracture and gives better coverage of the implant especially in the upper part of the breast which is potentially the most visible in a low  cut dress or bathing suit.

Bennett Yang, MD · Answer

Hello and thank you for the question and the photo. No implant feels 100% natural. However, for the majority of patients, the under the muscle implant is more natural in feel. The trade off is more pain, longer recovery, and sometimes the under muscle implant "jumps" when you flex the muscle. This can also happen with over the muscle implants, but is less common. Over the muscle implants do not feel as natural and there is a higher risk of capsular contracture You should have several consultations with board certified plastic surgeons in your area before making any final decisions. As always, it's best to be healthy, no smoking, and make sure any health conditions you have are managed by your primary care doctor. Best to you.

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Do over the muscle placed implants feel natural? (photos)

Answers (10)

Answer: Breast implant under or above the muscle

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Our mission is to create a world where every investment in modern beauty is Worth It.