Possible to Get Under Muscle Breast Implants Without Cutting Muscle?

Hi there-

Here are my thoughts....

There is no doubt in my mind that (unless you are a body builder and lift heavy weights for hours each day) you will be better off in the long term if your implants are placed under your muscle. Even though you are athletic.

The muscle modification that occurs in the average operation is NOT enough to permanently affect a patient's ability to engage in sporting activities, or limit her performance in them. I personally have several professional athletes as patients- all of them have implants under the muscle, and they are all able to do what they do without a problem.

The degree of modification is ideally individualized to the needs of each patient, in order for each patient to achieve her optimal outcome and as close an approximation as possible to her goals. Limiting your surgeon's ability to perform an important aspect of the surgery would not be in your best interests...

In other words, if you are able to dictate what happens to you muscle during surgery, but after surgery your breasts look funny or ugly to you, will you be happy? I doubt it....

It is very important that rather than focus on the details of what will happen in the operation, you spend that energy finding a surgeon you can trust and that you like and can get along with.

Once you've found such a surgeon, communicate your goals and concerns- then trust them to do what they do.

Honestly, some of the worst outcomes I have seen, in the most unhappy patients, have been when the patient was able to find a surgeon willing to alter what they would normally do to accommodate what the patient thought was in her best interests...

Here is some advice on how to best find a surgeon:

Possible to Get Under Muscle Breast Implants Without Cutting Muscle? Yes, it is possible but not desireable

The split muscle technique was specifically designed to avoid having to cut the muscle attachment on the ribs, which is done with the "dual plane" and every other version of implants under. When the muscle is detached this way, it may contribute to animation deformities when the muscle flexes. The split muscle technique leaves all of the attachments of the muscle intact, so function is not compromised, the breast doesn't distort as much with activity, and you still have coverage in the upper portion where it is most needed. The part that is left behind the implant would provide coverge in the middle, where the breast tissue is so the extra muscle coverage isn't as important. I developed the split muscle technique more than 6 years ago specifically for athletic women, and have done about 500 cases now. There is no other way to avoid cutting the muscle.

For the implants to sit properly, you need to divide the lower border of the pectoralis muscle. If you do not, the implants will sit too high.

As the other consultants have outlined, in development of the subpectoral, submuscular or dual plane pocket, most surgeons will release, divide or cut the muscle's attachments to the breast bone to ensure that the implant settles on the front of your chest wall and does not "lateralize" when you press your hands on your hips. 

I would agree that even in the most athletic patients, this surgical manuever does not compromise their ability to exercise, post-op.  Apart from the obvious recruitment of additional soft tissue (muscle) over the implant, which masquerades wrinkling and rippling, the dual plane is preferred because of the lower rate of capsular contracture and improved mammographic surveillance. 

If you want the most natural-looking breast, you will need a subpectoral implant, in which the implant is placed under the muscle. This procedure requires the merest incision—about three centimeters in the crease under the breast or at the edge of the nipple—and diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant, which occurs in 10 to 30% of cases.
Once the incision is made, the surgeon creates a pocket into which the implant is inserted, which in your case, would be located beneath the pectoral muscle underlying the breast tissue. Subpectoral implants aren’t right for everyone, though. If you have saggy breasts, an implant placed under the muscle won’t fill out that empty breast sack, and you’ll get what we call the “double bubble” look, where the breast hangs several inches below the implant.  

You do not necessarily need to have the muscle cut, but if it is left entirely intact, your implants will likely move when you contract your pectoralis muscle.  Many patients do not like this, so you just need to consider this prior to surgery.  Good luck, /nsn.

No, the muscle does not have to be cut in order for the implant to be properly positioned. I always leave the muscle intact along it's origin on the ribs and breast bone. There a few fibers that need to be released, but about 90% remain intact.
This does create greater risk of the implants moving up and requires a slightly longer recovery period, but fewer problems as far as loss of coverage of the implant, visible wrinkles or window shading of the pectoralis muscle. The pectoralis muscle does not need to be cut as long as your breast is not drooping. And, in these cases, I would recommend a lift and still not cut the muscle.

In order to place an implant under the chest muscle, the muscle must be separated from the ribs and breast bone in order to create a place which will center the implant under the nipple. If you know your anatomy well, you will see that the breast extends well below the chest muscle, and a correct sub-muscular augmentation will result in only the upper half of the implant under the muscle. This means that the muscle will be separated, cut, split, along the lower inner muscle attachment. Some surgeons may say that they don't need to cut the muscle, though I think this is only an issue of semantics. Call it what you like, it all means the same.
I have written frequently about sub-muscular augmentation, and despite the drawbacks of loss of muscular performance, or implant displacement, the advantages for most are so great that sub-muscular placement is the method of choice in 80% of breast augmentation candidates. It is not the only choice however and a sub-glandular gel implant may be right for you. Take your time to explore the option.
Best of luck,
peterejohnsonmd

Whenever I do a submuscular, which in my practice means subpectoral, there is always a small amount of muscle divided close to the sternum. This is done so the implant doesn't sit too far out and it doesn't "wink" when you flex the muscle. Some doctors have been placing them subfascial however I personally see no benefit to this. I know of no one who splits the pectoralis muscle and places the implant under the upper part and on top of the lower part.
Remember, that the muscle adds more tissue to the covering of the implant to give a more natural look, especially in a thin patient, as well as reducing the visible rippling.