As part of our series on breast augmentation, we would like to discuss how to choose the placement of your implant. Do you want your implant placed over or under the muscle? We’ll talk about the pros and cons of each approach and help you understand the terminology.

During breast augmentation surgery, we create a pocket for the implant that is either directly under the breast tissue (subglandular/over the muscle), or partially under the chest muscle (subpectoral/under the muscle/dual plane). Many of our patients prefer over the muscle with smooth round cohesive gel implants, but it’s great to have so many options available for customizing our approach.

Under the Muscle Placement

Under Muscle

Under Muscle

The pectoralis major muscle is the large, triangular muscle in the chest that’s responsible for helping us do push-ups, bench presses, and other pushing and pulling motions. In most women, the lower edge of the muscle crosses the chest a little below the level of the nipple. We can lift that muscle edge and slip a breast implant beneath the muscle, so the top part of the implant is covered by both the muscle and the breast tissue over the muscle. The bottom part of the implant sits under breast tissue only, since there’s no pectoralis in this area. You’ll hear this called “under the muscle”, “submuscular”, or “dual plane” technique.

The main advantage of this placement is added padding over the upper edge of the implant, particularly for thin women. The problem with submuscular implants is that whenever you contract your muscle, the implant will move too. Surgeons call this “animation deformity” or “dancing breast.” We tell our patients that it’s not harmful, but it is a strange party trick! We also see a slightly higher rate of implant malposition problems such as “double bubble” and bottoming out when implants are placed under the muscle, perhaps due to the action of the muscle pushing the implant down and out. More on that in a coming post.


Over the Muscle Placement

Over Muscle

Over Muscle

Improvements in cohesive silicone gel implants have given us more options, and many of our patients will now choose to have their implants placed “above the muscle” or “subglandular.” It’s less painful in the short term, but the main advantage is avoidance of that pesky movement that happens with submuscular implants. Subglandular implants are also a better choice for women who may have a bit of “sag” or deflation of their breast tissue but don’t quite need a breast lift. We like the way a subglandular implant enhances the natural shape of the breast, and we’re likely to recommend over the muscle if you’re choosing a cohesive silicone gel implant and fit the other criteria we have mentioned.

Patients often ask if the added muscle coverage is important for the protection of their implants. Breast implants are very strong, and the added layer of muscle does little to “protect” the implant from outside forces. Submuscular placement also will not do much to prevent breast sagging over time.  However, there is some evidence that mammograms may be easier for radiologists to read when implants are behind the muscle.

We’ve been in practice long enough to see many different types of implants come and go and we have ample experience with both under and over the muscle implant placement. At Banff Plastic Surgery, we tailor the surgical plan to each individual patient so you can be confident that you’ll receive personalized attention and a plan that’s right for you.

To learn more about our options in breast implant placement, contact Banff Plastic Surgery today at 403-762-2055.