Behind The Muscle Implants and Capsular Contracture?

Does Placement of a Breast Implant Behind the Muscle Decrease the Chances of a Capsular Contracture? Which method of breast reconstruction surgery is the least likely to result in capsular contracture?

Doctor Answers 10

Are implants under muscle better?

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The most common technique to place breast implants is either on top of the pectoralis muscle or under the muscle. Under the muscle placement has been shown on a number of medical studies to have a lower percentage of capsular contracture. Placing the implant on top of the muscle puts the implant in contact with breast tissue, increasing scar tissue around the implant. Placing the implant under the muscle also looks more natural, has less rippling and wrinkling and is easier to mammogram.

Breast Augmentation and capsular contracture

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Historically data has shown that capsular contracture with the submuscular or dual plane placement is lower than subglandular placement of the implant. This may change with today's devices.

Jeff Scott, MD
Everett Plastic Surgeon

Behind the Muscle implants and Capsular Contracture

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Medical studies do suggest a lower probability if the implants are placed under the muscle. To verify this is the optimal position for you, consult and have an in person exam with 3 -4 experienced and expert board certified plastic surgeons.

Capsular Contracture after Submuscular Breast Augmentation

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Theoretically, the muscle has great circulation and can lessen the chances of capsular contracture but their is no strong scientific data to support that.  Capsular contracture can occur with implants in a pocket beneath the implant the most common causes can be hematoma and/or infection.

Dr. ES

Alloderm helps prevent capsular contracture.

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Of course in breast reconstruction, implants should go under the muscle, but there are other things that prevent capsular contracture.  Some of them have been mentioned by other doctors.  The newest development is Alloderm (regenerative tissue matrix), which is placed over the implants during surgery.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Behind the muscle is better

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As hs been said, implants below the muscle have less capsular contracture in most experience.  The other benefits of this placement are less edginess, a better look, and better mammograms.

Muscle implants and Capsular Contracture

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Over 50 years of experience with breast implants have demonstrated that placing implants UNDER the pectoralis major muscle results in LESS scarring around the implants (Capsular Contracture) than having the same implants placed over the muscle.  Additional reduction in rates involve not touching the implant or skin ("No Touch technique") during placement, irrigating the pocket with dilute betadine or antibiotic solution, avoiding blood in the pocket and using of biological matrices such as Strattice.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon

Capsular contractures

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It is thought that behind the muscle minimizes the risk of capuslar contractures. There have been some studies that support textured implants are better but there are other studies that see no benefit to textured implants. The use of alloderm may decrease the risk of capsules as well in complicated cases.

Lower capsular contracture rates with implant breast reconstruction.

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Since your question refers to breast reconstruction, it is first important to know that placing the implants behind the muscle is important for coverage of the implants so going over isn't really an option. However, it is now routine to use an acellular dermal matrix graft such as Alloderm, which form a sort of internal bra to support the implant and cover the parts on the side and bottom where the muscle doesn't reach. This has dramatically lowered the incidence of capsular contracture as compared to under muscle implants without Alloderm.

Submuscular Breast Augmentation?

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Thank you for the question.

Yes,  I believe the incidence of breast implant encapsulation (capsular  contraction)  is decreased with implants placed in the sub muscular position.

Generally,I think it is in the best interests  most patients seeking breast augmentation surgery to have implants placed in the “dual plane” 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 in the sub glandular position. 

I hope this helps.

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.