Over or under muscle?

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

Thank you for your question! Over the muscle placement (subglandular) can create a fuller, rounder look without extra muscle involvement, which can sometimes be ideal for patients looking for a strong, noticeable upper pole fullness. For naturally smaller and leaner patients, there’s a higher chance that the implants may be more visible or feel less natural, especially in the upper part of the breast, which is why visibility can sometimes be a concern for patients with less breast tissue. However, under the muscle placement (submuscular) can provide a more natural look, especially for patients with small breasts and a lean build, as the muscle helps to camouflage the implant. In your case, the choice depends on your priority for either a fuller look with quicker recovery (over the muscle) or a more natural look with minimized implant visibility (under the muscle). Both options can be tailored to give great results, but based on your thin frame and small natural breast size, the recommendation for under the muscle might indeed help achieve a softer, more natural result.