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

Question

What is the difference and the pros and cons of each. I want these for silicone implants with the armpit incision. Thanks in advance

Gary M. Horndeski, MD · Answer

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.

James E. Chappell, MD · Answer

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.

Steven Wallach, MD · Answer

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.

Jonathan Weiler, MD · Answer

There is a difference between the two, many surgeons place the implants beneath the muscle without releasing the insertion of the pectoralis (chest muscle) into the rectus muscles (abdominal ) , this is a true below the pectoralis muscle placement, a true dual plane technique releases the insertion of the muscle to allow for the lower pole of the breast to open up to allow for a better shape, this technique can be done with a transaxillary (armpit) incision if it is done under direct visualization with a camera and a cautery (cutting device) . It is safe and provides excellent results, but not many surgeons practice this technique ( using a camera to achieve a dual plane technique thru the armpit) Good luck, and do not be afraid to ask your doctor about his techniques and what technique he uses. There is really no right or wrong with these techniques, just opinions

Marcus L. Peterson, MD · Answer

No one is doing a full muscle coverage of breast implants.  There is a lot of confusion in the description of the muscle pocket.  The dual plane technique is common but can lead to bottoming out and double bubble.  The standard subpectoral pocket is what is achieved with the armpit incision.  Have you surgery with an experienced board certified plastic surgeon and you will have the best chance for a great result.

	Best Wishes

	Dr. Peterson

Peter E. Johnson, MD · Answer

Many years ago there was talk of full muscle coverage for breast implants to provide a 'muscular bra' for support. The anatomy is such that this required placing the implant under the chest muscle,the abdominal muscle (rectus) and the side chest muscle (serratus) which was difficult, painfull, and altogether unnecessary. Submuscular implants are all in reality 'dual plane' covered by muscle above, and the breast below. There should be a good connection or marriage between the implant and the breast and the full muscle coverage idea has little in its favor.

Paul Loewenstein (retired) · Answer

Submuscular implants are in reality subPECTORAL implants. Rarely does a plastic surgeon place implants in a totally submuscular location. I actually saw a patient recently who was done in another city 10 years ago and who had total muscular coverage, meaning additional muscles were used in addition to the pectoralis muscle. Suffice it to say it looked weird. This has unfortunately become a confusing subject for patients, because of the terminology used. If by "partial under the muscle" one means under the pectoralis muscle, then that is in reality the way the vast majority of us perform implants that are "under the muscle." Good luck.

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