Above Muscle or Below? Where Should my Breast Implants be Placed?
If a woman has not undergone prior breast surgery, I place the vast majority of implants below the pec major (pectoralis major) muscle. Why? Submuscular breast implants have the following advantages:
1. Reduced risk of capsular contracture.
The scar tissue around the breast implants is less likely to become excessively tight if it is being stretched constantly by the motion of the overlying muscle.
2. Reduced risk of interference with mammograms.
Although any breast implant may interfere with mammograms, the muscle can be used as a divider to separate the overlying breast tissue from the underlying subpectoral implant.
3. Reduced risk of excessive implant descent or “bottoming out.”
Breast implants placed below muscle are supported by the overlying muscle. In contrast, implants placed above muscle (subglandular breast implants) are supported only by the overlying skin and breast tissues.
4. Reduced risk of visible implant rippling.
All breast implants ripple along their edges. Saline breast implants ripple more than silicone gel breast implants. When implants are placed below muscle, the upper inner two-thirds of the implants are covered by the pec major muscle, significantly reducing the extent of rippling.
5. Reduced risk of unnatural bulging of the upper breasts.
The pectoralis major muscle blunts the junction of the upper implant edge and the chest wall, generally yielding a more natural breast appearance.
Subglandular (above muscle)
(with capsular contracture)
Subpectoral (below muscle)
On the downside, placing implants below muscle requires greater surgical time, effort, and skill and usually results in more immediate postoperative discomfort. In athletes, implants below muscle may sometimes weaken the pectoralis major muscle, and the implants may “jump” with forceful muscle contraction. In my 16 years of private practice, however, the advantages of subpectoral implant placement have far outweighed the disadvantages in the vast majority of women.