Above Muscle or Below? Where should I place my breast implants?
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 submuscular 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.
On the downside, placing implants below muscle requires greater surgical time, effort, and skill and often causes 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 15 years of private practice, however, the advantages of subpectoral implant placement have far outweighed the disadvantages in the vast majority of women.
Click here to watch a video about my breast augmentation technique and results.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas