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

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!

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.