Over or under muscle?

Hi thanks for this question. You have had a couple of different opinions because both techniques come with advantages and disadvantages so its a case of weighing up the up- and down-sides of each technique and trying to match this as closely as possible to your breasts, physique, lifestyle and expectations:
Under-Breast implant plane ‘Subglandular’
advantages:
- most natural place for implant
- fills the breast ‘envelope’ evenly

disadvantages:
- implant is closer to surface - more likely to feel or see shape of implant, or have ripples - may be important for patients who are very thin or who have very small breasts to start with and/or who want a particularly large implant

Under-Muscle Implant plane (‘Sub muscular’ or ‘Sub Pectoral’ or ‘Dual Plane’)
advantages:
- muscle covers the upper part of implant so this makes it less easy to feel / see shape of implant
- muscle flattens the upper part of a round implant and this can provide a more ‘natural’ shape (i.e. flat rather than rounded down-slope)
- the effects of capsule contracture (tightening around the implant) may be less - although this is controversial and capsule contracture occurs with under muscle implants too

disadvantages
- breast envelope may not fill as evenly
- the implant may sit a bit higher whilst the breast itself slides downwards - may be a problem if the breast already is a bit droopy (‘ptosis’)
- the implant may move with the muscle - ‘animation’ of the breast
- possibly more discomfort after surgery
- the movement and position of the muscles tends to widen the cleavage
- implant may still be feelable in the lower part of the breast because the muscle doesn’t cover the bottom part of the implant.


overall if you are skinny, i think this is probably the strongest reason to favour under-muscle placement Try to pinch up the skin in the upper part of the breast about half way between nipple and collar bone - if there is less than 2cm, maybe 1.5cm, of pinch width then its a strong recommendation to go under muscle in my opinion. But if you like lots of exercise / workout and especially if you do an upper body / arm sport eg tennis/rowing/climbing it could be a disadvantage to go under the muscle because you will use this muscle a lot so you can anticipate much more movement and compression of implant and may also be prone to some discomfort with your sport although as far as I am aware there is no proof that muscle strength is affected.

Hi,

Choosing between over or under the muscle implant placement is complex. Firstly, it's essential to understand the terminology: "submuscular" means under the muscle; "subglandular" means under the breast tissue, over the muscle and muscle fascia; and "subfascial" means over the muscle but under the pectoralis fascia. A surgeon's experience and your body type heavily influence this decision. Surgeons often prefer the approach they've had the most success with for similar body types. If you have minimal chest tissue, submuscular placement helps avoid an unnatural, abrupt transition between the chest and breast. However, if you have good breast form and desire a small increase in size and projection, subglandular placement might be suitable. The subfascial approach, offering most advantages of submuscular placement without disturbing or injuring the muscle, is gaining popularity. For those who exercise regularly, over the muscle placement is recommended to prevent "animation deformity," where implants move laterally and inferiorly, potentially causing distortion, displacement, or flipping when contracting upper body muscles. Ultimately, discussing your aesthetic goals, anatomy, body type, and lifestyle with your surgeon is crucial for deciding the best implant placement.

My comments and recommendations are solely based on your text and are subject to change. I always recommend a face-to-face consultation with a specialist to plan the treatment.

Best wishes, Dr. Surmeli.

Dear Pioneering26540,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery