Breast augmentation going in front or behind the muscle?

I'm getting it done in 2 weeks with a really great Dr..But he said I must go behind the muscle and not in front due to my nipples are starting to point down..I'm a small B and never had kids..I'm going 500cc each....said I have plenty of tissue but still makes me nervous as I want them to feel soft as possible ..they are silicone and I'm 48...Wendy

Doctor Answers 10

Breast implant placement above or behind muscle

Your doctor is trying to provide you with the benefit of his experience. Many physicians almost exclusively place breast implants under the muscle.  There are distinct advantages and disadvantages.  Other surgeons prefer a subglandular placement with perceived advantages in their hands.  I would recommend you review this with your surgeon as to his preference and why.  Review before and after photos of your surgeon's own patients to understand his approach.  In this way you can feel more confident in your choice. 


Virginia Beach Plastic Surgeon
5.0 out of 5 stars 9 reviews

Implants in front or behind the muscle?

Thank you very much for posting this question. This is important for patients to understand and feel comfortable with prior to surgery. There is only one drawback with placing the implant behind the muscle and that is because the implant will shift slightly in the pocket when the chest muscle is flexed. All other outcomes (softness, natural appearance, longevity, etc) of the implant is improved with the implant behind the muscle.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 250 reviews

Breast augmentation going in front or behind the muscle?

Thank you for the question. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.



I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.


On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.    Best wishes with your upcoming surgery.

BA going in front or behind the muscle

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 andrecovery 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

Breast augmentation going in front or behind the muscle?

Thank you for your question and I understand your concern with this decision. It's important to understand that there are benefits to placing implants under the muscle. The muscle adds another layer of camouflage to the implant. Under the muscle the implant is less noticeable, there is less chance for rippling or a palpable edge, and the top of the implant is pushed down by the muscle to give a smoother contour between the upper chest and the top of the breast. Submuscular placement also decreases the risk of developing a capsular contracture. Capsular contracture is overly thickened scar tissue that forms around the implant. It's a challenging problem to fix. The most important thing is careful communication with your surgeon. If there's something that you don't understand you should get in contact with them so that you can have a discussion about your concerns. With any surgical procedure you want to be able to move forward with confidence. Congratulations on your upcoming surgery. 

Sub muscular breast augmentation is the state of the art

There are a variety of functional and cosmetic reasons to place silicone breast implants behind the muscle, rather than on top of the muscle. 

Breast augmentation going in front or behind the muscle

That is a little confusing as placing the implants below the muscle will not alter the direction your nipples are pointing, especially with larger sized implants. I cannot say much more without photos of what you are talking about

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Sub-pectoral vs. Subglandular augmentation

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:

·      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 faster when compared to subpectoral augmentation.

 

·      Subglandular 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.

 

Subpectoral Augmentation:

·      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.

 

Each approach has both (+) and (-). Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other depending upon their goals/expectations and the specifics of their exam.  As always, your board certified plastic surgeon can help guide you in your decision making process.

Donovan Rosas, MD
Westchester Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

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

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon


Breast implants - behind or in front of the muscle?

Thank you for asking about your breast implants.

  • The plan to put them behind the muscle sounds good -
  • It will make it more likely that they will stay soft for you.
  • Be sure these are the right sized implants for you - they are on the large side, nothing wrong with that if it's the look you want.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

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.