Which is better: under or over the muscle breast implants? What's the difference & pros/cons for each?

There are choices for breast
implant placement: sub-glandular (under the breast tissue and in front of the
chest muscle – the pectoralis muscle) or sub-muscular (under or partially under
the chest muscle). The best location depends on many factors including: tissue
thickness, weight, desired outcome, and individual anatomy. Each position has
advantages and disadvantages:

Subglandular implant benefits:


A shorter recovery time.
Less discomfort initially.
No distortion of the breast when the pectoralis muscle
flexes.
Mild preoperative sagging can be improved, especially
if no breast lifting procedure is performed.
Easier surgical procedure.
Larger implants can be placed.


Subglandular
implant disadvantages:


The implant may be more visible.
More visible rippling, especially in patients with a
small amount of natural breast tissue.
Generally, saline implants do not produce a good result
in front of the muscle.
Higher incidence of capsular contraction.
“Bottoming out” in some patients.
Some radiologists have more problems reading a
mammogram with an implant in front of the muscle.


Submuscular implant benefits:


Usually results in a better appearance for naturally
small breasted women
Less tendency for seeing ripples of the implant.
A more natural feel to the breast especially in slender
women who don’t have much of their own breast tissue.
Less interference with mammograms, although most
radiologists take additional views no matter where the implants are
placed.
Lower rate of capsular contraction.
Less of a chance of “bottoming out” where the implant
bulges at the lower aspect of the breast and the nipple and areolas tend
to appear excessively elevated.


Submuscular implant disadvantages:


Recovery usually takes a little longer and is more
uncomfortable initially.
There may be an “animation deformity”, which is a
temporary distortion of the breasts when the pectoralis muscle is flexed.
Body builders and weight lifters generally prefer implants in front of the
muscle.
It is harder to achieve cleavage in women who have
widely spaced breasts.
The implants often ride higher on the chest.


Actually, most patients who have
breast augmentations today have breast implants placed in a combination or
“dual plane” position. This approach has the same benefits and disadvantages of
a total “submuscular implant”, but with a lesser tendency to ride high on the
chest wall. The disadvantage as compared to a total “submuscular implant” is a
higher tendency for bottoming out.

The ideal placement in any
particular patient depends on their particular anatomy and understanding of the
pros and cons of each approach.

Keep in mind, that following the advice
from a surgeon on this or any other website who proposes to tell you what to do without seeing photos and more importantly without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of each operative procedure may not be in your
best interest. I would suggest you find a plastic surgeon certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with.
You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Hello,There are pros and cons for both. Many patients with small, firm breasts will do well with sub muscular placement to provide a more natural look and other benefits. Sub mammary can be an excellent choice however when there is a slight amount of sagging or pseudo ptosis as they will "fluff" out and give a perkier look to the breasts. Sufficient tissue and fat must be present in the upper chest to make this placement look appealing. Your Plastic Surgeon will examine and measure you, talk about your expectations and recommend the placement and implants most appropriate for you.All the best

Hello, there are several advantages and disadvantages of the two pockets.  One major obvious advantage of under the muscle (subpectoral pocket) is more tissue covering the implant, which decreases the risk of seeing or feeling the implant.  However, the muscle tends to act like an "internal bra" and hold the implant in place, so for people with sagging breasts the implants might look like they are sitting high on the breasts while the nipple remains low.  When deciding on the best pocket for a given person, the surgeon must take into consideration several factors.