Thank you for
The decision to go with over or under the muscle truly depends on your surgeon’s assessment, your goals, etc.
Without an in-person exam, no one can say which pocket would be best for a particular patient.
Open communication with your surgeon is important. Remember, you should never make decisions without understanding their
That being said, I can provide you with advantages and
disadvantages of the over the muscle and under the muscle implant placement.
Firstly, the decision to go behind the
muscle or over the muscle has to do with the amount of soft tissue coverage –
“padding” 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
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
- 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
There is a difference in opinion, but under the
muscle (partially submuscular) is the best option 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 just make your breasts appear round and
is important that you communicate your goals very clearly, but understand that
you need to have realistic expectations.
this helps, and best of luck!