Breast Implant Placement: Above or Below the Muscle?

Where Should One Place their Breast Implants? Above or Under the Muscle?

Implant Pocket Selection

One of the most important decisions prior to a breast augmentation procedure is the selection of the breast implant pocket. The clinical manifestations of this may not be apparent for several years since the effects of the implant on your breast tissue may occur gradually. Sagging of the breast may inexorably worsen, especially after giving birth and with aging.

Different Breast Implant Pocket Selections

  • Total Submuscular (behind the serratus and pectoralis muscles of the chest)

  • Partial Submuscular (behind the pectoralis muscle of the chest with its origin from the ribs left intact)

  • Subglandular (above the pectoralis muscle of the chest)

  • Dual Plane (partial submuscular and partial subglandular/submammary)

Total Submuscular

  • Mostly a reconstructive technique

  • Less commonly performed for a breast augmentation

  • More painful

  • More bloody due to the dissection during surgery

  • The breast implant may have a tendency to rise superiorly

Submuscular Placement of a Breast Implant (Courtesy of Wikimedia Commons & Inamed)

Partial Submuscular (Under the Muscle)

  • Breast animation and distortion may occur when the pectoral muscles contract.

  • Lower incidence of capsular contracture.

  • Risk of double-bubble deformity of the breast.

  • More painful than a subglandular breast implant placement.

  • Decreased risk of the palpability of the implant edges

  • Decreased risk of rippling

  • It allows for better view during mammography.

  • It's associated with a longer period of recovery, and more post-operative discomfort.

Subglandular (Over the Muscle)

Subglandular Placement of Breast Implant (Courtesy of Wikimedia Commons & Inamed)