Hi. I'm Dr. Dan Shipirro. I’m a plastic surgeon certified by the American Board of Plastic Surgeons. I've been performing plastic surgery in the Scottsdale Paradise Valley area since 1992. A lot of what I do is facial surgery and breast augmentation surgery. People often want to know what is the difference and what should we do with regards to putting a breast implant above or beneath the pectoralis muscle and when is it done. The first thing to understand is the breast augmentation can be put either above or below the muscle. And specifically we do it for different reasons. I think across the board most plastic surgeons and myself included would prefer to put a breast implant beneath the pectoralis major muscle.

The reason being is that I think that we see a smoother contour with regards to seeing the implant. I think the capsular contraction rate, which is the hardening of the implant is lower across time. And I think that you'd be less apt to see rippling or feel any irregularities with the implant. There are certain instances where a breast implant is best when it's above the muscle. I think the first person for that would be somebody who has some droopiness to their breasts that does not want a breast lift. And that could be treated with a breast implant above the muscle. There are specific implants now that have more projection than others so often times a high profile implant or even a teardrop-shaped implant can be put above the muscle to give a more natural contour for somebody that has some breast ptosis or breast droopiness and does not want to have a lift.

There is a slight increased risk of capsular contracture and for that we often put a textured silicone or saline implant in. For the most part though, we prefer beneath the muscle. The other category of people is somebody who is an active weight lifter. Or a person who does body fitness contests. Often times their pectoralis muscle is so developed and they are so busy flexing their muscles that they could see a displacement with the implant or see something that looks unnatural with regards to the configuration of the pectoralis muscle and the implant. So for that other person we like to put them if we can above the muscle. But there is nothing wrong with having an implant above the muscle. I just think that every case is different. And basically the best way to get an idea about what you should do would be to get a consultation with a board certified plastic surgeon. The most important thing with regards to plastic surgery I think is who is performing it. And I think you need to make sure you go to somebody with a lot of experience. Ask to see their before and after photos. Ask around. That puts you in the driver's seat. Thank you very much.

Breast Implants Above the Muscle: Do the Benefts Outweigh the Risks?

Dr. Daniel Shapiro discusses the difference between placing breast implants above the muscle (subglandular placement) or beneath the muscle (submuscular placement), and who are the candidates that can have these operations done.