Over the Muscle vs. Under the Muscle In Breast Augmentation Surgery

When undergoing breast augmentation surgery using breast implants, the placement location of the implants is a very important decision and one that should be discussed with a plastic surgeon. This decision can have a profound effect on your ultimate results, both short and long term.
breast-augmentation-before-and-after-photos

Implant Placement Options

Breast implants are inserted either under (behind) the pectoralis major chest muscle or over (in front of) the chest muscle but behind the breast tissue itself. When placed under the muscle, this is referred to as the subpectoral or submuscular position. When in front of the muscle, this is called the subglandular or submammary location.

Why Some Surgeons May Recommend Over the Muscle

There are a few reasons why some plastic surgeons may recommend implant placement over the muscle. These can include:

  • Surgeon preference that may be influenced by training experience
  • It is a technically easier procedure to perform.
  • Discomfort immediately after surgery is less, and there is a slightly shorter recovery
  • There are no dynamic implant deformities (that in some situations may be obvious to others) as a result of chest wall muscle contraction. This can be of particular importance for some such as body builders.
  • With a minor degree of skin laxity present (and when considering relatively small breast implants) a breast lift may be able to be avoided – at least initially.

Why Dr. Turkeltaub Recommends Under the Muscle

For most women, Dr. Turkeltaub recommends that breast implants be placed under the muscle for multiple reasons. These include:

  • There is better long term tissue support of the implants in a submuscular pocket from the overlying muscle and other tissues compared to just skin support when they are placed above the muscle. This translates into maintaining breast shape longer. Larger implants placed above the muscle tend cause and accelerate skin stretching and thinning resulting in droopy, deformed breasts.
  • Mammograms generally are more easily read and interpreted compared to when they are placed in a submammary pocket.
  • The risk of capsular contracture is lower.
  • Implant rippling and palpability is lower. This is an even greater issue in thinner women and those selecting saline implants.
  • The breasts will usually look and feel more natural due to greater soft tissue coverage of the implants. Conversely, the “bolted on” look is associated with larger implants placed above the muscle.

The decision as to whether your breast implants should be placed under versus over the muscle for your breast augmentation is an extremely important one and should be thoroughly discussed with your plastic surgeon. During your consultation, board-certified plastic surgeon Dr. Steven H. Turkeltaub will answer all your questions regarding implant placement and all other breast augmentation issues. To schedule your complimentary consultation with Dr. Turkeltaub, call (480) 451-3000 or complete our online contact form today.