Best Breast Implant Placement – Under vs Over Muscle Placement

All You Need to Know About Breast Implant Placement Options

Breast augmentation surgery using implants is a procedure wherein prostheses are used to change the size, shape, and contour of the breasts, thus improving their appearance. This is best the solution for tuberous breasts as well. Breast implants are placed in pockets made either in front or behind the Pectoralis major muscle. There are variety of breast implant placement techniques and Dr Doyle apply the best one depending on your aesthetic goals for undergoing a boob job (breast augmentation).

Pocket Placement of Breast Implants

An incision can be made either in the crease under the breast, around the nipple or in the armpit. Dr Doyle prefers using an incision in the crease under the breast as these scars heal well and the surgical results are much more predictable.  A breast implant can be placed in two  primary pocket locations namely:

1. Over the Muscle or Sub-Glandular

In a Sub-glandular implant placement, the breast implant is positioned under your breast tissue but above your chest muscles, also known as the pectorals.

2. Under the Muscle or Sub-Muscular or Dual Plane.

The breast implants in this technique are placed under your pectoral muscles. As the implant is placed partially under the chest muscles. The pectoral muscles cover the upper two-thirds of the implant, and the remaining third of the implant is covered by the breast tissue.

The following factors will help determine the optimal implant placement site for each patient, including:

• The size of your breast and availability of breast and fat tissues
• Your health condition
• Size of the implant to be used
• Type of implant to be used
• Size and position of the pocket
• Your expectations from the procedure

Sub-Glandular Breast Implant Placement – “Over the Muscle”

Over the muscle implant placement is commonly known as sub-glandular. The implant is placed between the breast tissue and the pectoral muscle. It may, depending on the type of implant used, elevate the nipple and areola slightly without the need for a breast lift.

Advantages

The advantages of sub-glandular implant placement are:

• Flexing of the pectoral muscles doesn’t change the shape of the breasts. Such movement and distortion of the implants placed under the pectoral muscle is called animation.
• It will raise the breasts in patients whose breasts are sagging a bit. If a shaped (teardrop) implant is used, then you may not require a breast lift.
• The implants placed over the muscle will descend as the breasts age and naturally descend downward — giving your breasts a natural look years post-surgery.
• Recovery is faster and pain associated is less than a submuscular placement.
• The resulting shape and size can be seen earlier.

Drawbacks

The disadvantages are:

• There is a higher risk of capsular contracture.
• There is a risk of the implant bottoming out unless the tissues below the implants have been surgically supported.
• Implants may become visible, particularly at the top of the breast when patients have a small amount of breast tissue and the implants are large.
• Rippling or wrinkling of the implants is easier to see if it occurs.
• Mammograms will become harder to read.

Am I a Good Candidate For Sub-Glandular Breast Implant Placement?

Sub-glandular breast implant placement could be for you if:

• Your breasts are completely developed.
• You have enough breast tissue to conceal the implant.
• You have a mild degree of sagging.
• You have unusually shaped breasts.
• You desire a fuller appearance of your breasts.

Sub-Muscular Implant Placement – “Under the Muscle”

In the sub-muscular implant placement method, the breast implants are placed underneath the pectoral muscles. This technique is preferred in breast augmentation as the aesthetic outcome is more natural.

Advantages

The advantages of a submuscular implant placement include:

• The results are a more natural-looking breast contour, especially in patients who have small amounts of breast tissue or fat.
• Reading mammograms is easier i.e. more breast tissue can be visualised.
• Lower chance of capsular contracture.
• The chance of the implant bottoming out is lower.
• Lowers chances of rippling of implants and visibility of the upper implant border as the pectoral muscles cover the upper two-thirds.
• Gives the breast a natural teardrop appearance and a much fuller appearance
• Decreases the risk of double bubble formation.
• Can also improve minor breast sagging.
• Depending on your goals, a natural and fake-looking breast enlargement can also be achieved.

Drawbacks

The disadvantages of an implant placement under the chest muscle are:

• Post-surgical recovery is slightly longer when compared to the recovery of the post-sub-glandular implant placement method.
• Breasts will take a little longer to settle down into their optimal position and shape hence delaying the result.
• The implant can displace over time because of the constant force of the muscle on the implant.
• Flexing of the chest muscles flattens or moves the implants outwards. Due to this reason, implants placed under the muscle are not recommended for professional bodybuilders.
• There is greater discomfort associated with this procedure as it is more invasive and the muscles are constantly stretching to accommodate the implant.
• Bottoming out of the implants is a risk.
• Increased risk of wrinkling or rippling of the implants in the lower third, where it is covered by breast tissue alone.

Am I a Good Candidate for Sub-Muscular Implant Placement?

You may be a good candidate for sub-muscular implant placement if:

• Your breasts are completely developed.
• You have smaller and flatter breasts
• If your breasts are not sagging
• You are looking for a natural result
• Your breasts are completely developed.
• You have a small amount of breast tissue.
• You have lost weight, especially after pregnancy.
• You have a minor degree of sagging.

This type of technique provides a more natural-looking enhancement of the breast, even in women with a very low amount of breast tissue.

Which Placement Is Best for You?

During your initial consultation process, Dr Doyle will examine you and explain the different breast pocket placement options available to you. As each case is individualised, a single approach to implant placement that is ideal for every woman is not possible. Based on your desired goals and your body, Dr Doyle will choose the placement and technique that he will use.

Factors that may determine the best approach for you include:

• The extent of sagging of the breast
• Amount of available breast tissue
• The need for repositioning of breast tissue relative to the chest muscle

Frequently Asked Questions

What is the safest breast implant on the market?

Silicone-based implants are generally considered low risk to use as even if these implants rupture or leak, the silicone gel remains within the shell of the implant or inside the implant pocket.  Detecting rupture of such implants can be difficult and often needs an ultrasound or MRI to detect.

Dr Doyle believes Motiva Breast Implants are the more optimal breast implants available.

How painful are breast implants when placed under the muscle?

When compared to breast implants that are placed over the muscle, implants placed under the muscle are more painful during recovery. But the pain is usually minimal and is well controlled with pain killers.

Is it better to go under or over the muscle?

There is no concrete answer as to which type of implant placement is the best as each case is different. The factors which play a key role in determining the type of implant placement to be adopted include:

• Breast size and available breast tissue
• Your health condition
• Size of the implant
• Type of implant to be used
• Size and position of the pocket
• Your expectations

What breast implants look the most natural?

Silicone teardrop-shaped implants look more natural compared to other available implant options.

How long do breast implants last?

On average, a silicone implant can last anywhere between 10-25 years. You may get your breast implants removed earlier if you have any cosmetic concerns or any complications arise.

What are the pros and cons of getting breast implants?

Pros:

• You may feel you’ve achieved your aesthetic goals.
• The implant is customised to fit your needs and size requirements.
• The placed implant lasts for a long time.

Cons:

• As it is a surgical procedure, it is associated with certain amounts of risks. The chances of risks can be lowered when done by an experienced practitioner.
• Breast implants do not last forever and you will need a second operation in your lifetime on your implants.
• Breast implants can cast shadows during mammography, making it difficult to detect breast abnormalities. You might require multiple films to get a clear result.

Is it safe to do pushups with breast implants?

After breast augmentation, especially with submuscular implants, you should try to avoid exercises causing excessive strain to the chest such as planks, push-ups, bench presses. Contraction of your chest muscle places downward and outward pressure on the implants underneath and over time can result in the implants dropping or becoming displaced. The use of a supportive bra is advised while exercising and you should consult with Dr Doyle about the exercises you can and cannot do immediately after surgery.

For more information on this, view our blog, Exercising After Breast Augmentation Surgery.

How long does it take to recover from breast implant surgery?

It takes approximately three to six weeks to recover after breast implant surgery. But you may need longer if your implants are placed under the muscle.

Following Dr Doyle’s cosmetic surgery recovery tips and also his special wound healing diet may help you to have a quicker recovery.

Will breast implants affect my ability to breastfeed a baby?

The addition of implants should not affect your ability to breastfeed as the implants are placed below the breasts and not in them.

Do breast implants feel different to touch?

Yes. Different implants have different types of silicone inside the bag and can feel quite different.  Silicone-based breast implants imitate the touch of natural breasts and feel natural as long as they are not too large.

Will my implants look bigger if I lose weight?

Your implants won’t get bigger if you lose weight, but they can look larger on your smaller frame.

What are the common risks associated with breast implants?

Breast implants are commonly associated with the following risks, including:

• Wrinkling of skin over the implant
• Faulty position of the implant
• Systemic symptoms, known as Breast Implant Illness (BII)
• Implant leak or rupture
• Infection
• Capsular contracture
• Breast pain
• Additional surgeries to remove the ruptured or rotated implant
• Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL)(in textured surface implants only)  These implants are no longer used in Australia
• May hinder cancer screening imaging modality like a mammogram

Book a Consultation

If you are considering breast augmentation, book a consultation with Specialist Plastic Surgeon, Dr Mark Doyle on the Gold Coast.

Related Blogs

• Combining Plastic Surgeries: When Can Multiple Procedures Be Combined? 
• 5 Ways to Get Natural-Looking Breasts
• Exercising After Breast Augmentation
• Choosing the Best Breast Implant Size
• Mini Boob Job: Small Breast Implants for Petite Women (Breast Augmentation)
• Motiva Breast Implants and Why Dr Doyle Thinks They Are Best
• Nipple Reshaping – Areola & Nipple Surgery: What to Expect
• What Is Breast Implant Malposition and Breast Implant Flipping?
• Breast Implant Illness – Everything You Need to Know

Medical References

1. Breast Implant Placement: Over or Under the Muscle? | Toronto Cosmetic Surgery Institute 
2. Dr. Parker Explains Why the Over vs. Under the Muscle Breast Implant Placement Debate is Over 
3. Breast Implants Sydney- Should breast implants be placed under or over the muscle? 
4. Breast Implants: Over or Under the Muscle? | Implants Under Muscle
5. Over or under the muscle? The four options for breast augmentation and how to decide | Dr Baxter, Seattle Plastic Surgeon