Partially Under the Muscle Vs (Fully) Under the Muscle For Silicone Implants Pros and Cons?

You want silicone implants through armpit incisions.  Silicone implants usually require large incisions because they cannot be filled within the breast.  Ideally, implants should be under the muscle completely as possible.  Smaller size implants are more easily covered by the muscle.  Larger implants may extend outside the muscle envelope.  The disadvantage is that muscle contractions can dislocate the implant inferiorly and the implants migrate out of the submusclar position.  My advice to you is to use the smallest implants placed as high as possible and covered by as much muscle as possible.  I use a circumareola approach that allows me to lift the breast tissue, areola and place the implants high.  It results in a more youthful, athletic, thinner appearance with more projection.

Best of Luck,

Gary Horndeski, M.D.

I prefer to put the majority of my patients' breast implants subpectoral, which is "under the muscle" to most of us.  They are actually done with the "dual plane" technique (which most of us were doing before someone named it that).  So they are under the pectoralis muscle for their upper 1/2 or so, and under breast tissue for the lower 1/2 or so.  This is, IMHO, not as reproducibly done using the "armpit" (I say transaxillary) approach, so I don't usually do it that way.  Why under the muscle?  Pros: Possibly less chance of interfering with mammograms and possibly lower chance of hardening of the implant capsules, more natural upper breast slope and less visible upper breast rippling.  Also, in thin women, less "fake" look.  Cons: positional distortion possibly (when the woman puts her hands on her hips and squeezes her "pecs" the implants may ride up).  Most women accept this as a trade-off for the above "pros".  Best of luck to you.

Fully submuscular implants usually do not sit well and with time the breast tissue falls over the implant. I prefer a partial submuscular pocket or dual plane approach.