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

Most studies show less (often about 3 times less) capsular contracture below the muscle. Implants above the muscle almost never have muscle implant motion.  Implant motion can be minimized with proper placement below the muscle. I give every patient the options of submuscular vs subglandular (above muscle) placement, but virtually all of my patients choose submuscular placement and I agree the long term problems are less below the muscle.    

I have been doing breast augmentations a very long time.  I have put several thousand implants above the muscle and several thousand below.  My experience is implants below the muscle stay softer, look more natural, allow for a better more easily read mammograms, and show less rippling.  Implant bottoming out and inframammary scar riding up into the breast are more common above the muscle.  Implants above the muscle are less natural looking, and I don't recommend them to anyone unless they want the truly fake look for some reason or another. 

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.

Thank you for your question.  In the majority of women I recommend they have their implants placed beneath their chest muscle as this provides a natural appearing breast, with improved soft tissue coverage helping to minimize implant palpability and rippling, and sub muscular placement trends towards lower overall complications.  The motion that you are describing is termed an "animation" deformity and does occur in some women with implants placed below the muscle, but not above.  Animation deformity occurs when the chest muscle contracts, forcing the implant in a down and out direction.  This does not harm the implant, and the implant will return to his previous position once the muscle is not actively contracting.  See a board certified plastic surgeon for an evaluation. They can offer recommendations on implant placement specific to you. 

I appreciate
your question.



The best way
to determine implant size is based on chest wall measurements that fit your
body. Once we determine that we can choose the profile based on what you
want or need to achieve.



Implants
under the muscle, there is less risk of capsular contracture. Anatomic
implants tend to give a more natural shape with more nipple projection.



The best way
to assess and give true advice would be an in-person exam. Please see a
board-certified plastic surgeon that specializes in aesthetic and restorative
breast surgery.



Best of luck!



Dr. Schwartz

The benefits of UNDER the muscle are: lower risk of capsular contracture, less interference with mammograms, more natural look on the upper pole, less visibility and less palpability of the implant. The only downside is animation -- yes, they move when you flex your pec. Personally, I think the benefits WAY out way the negatives. 

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

Thank you for the question.

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in these sub muscular position.
Best wishes.