---
title: "Breast Implant Placement: Over, Under, or Dual Plane?"
url: https://drturner.com.au/blogs/best-breast-implant-placement-over-the-muscle-under-the-muscle-or-dual-plane/
date: 2025-05-08
modified: 2026-07-31
author: "Dr Scott J Turner"
description: "Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) Key Takeaways There are three main placements: subglandular (over the muscle), submuscular (under the muscle), and dual plane (a combination). Each..."
categories:
  - "Breast Augmentation"
  - "Breast Implants"
tags:
  - "Breast Augmentation"
  - "Breast Implants"
  - "Dual Plane"
  - "Subfascial"
  - "Subglandular"
  - "Subpectoral"
image: https://drturner.com.au/wp-content/uploads/2024/04/blogplaceholder-img.svg
word_count: 2414
---

# Breast Implant Placement: Over, Under, or Dual Plane?

*[Dr Scott J Turner](https://drturner.com.au/dr-scott-turner-sydney-plastic-surgeon/) | Specialist Plastic Surgeon (FRACS)*

> **Key Takeaways**
>
>
>
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> - There are three main placements: subglandular (over the muscle), submuscular (under the muscle), and dual plane (a combination). Each has genuine uses and genuine trade-offs.
> - Dual plane is used in the majority of modern augmentation cases because it combines muscle coverage at the upper pole with tissue drape at the lower pole. Subglandular and pure submuscular are used for specific reasons rather than as defaults.
> - "Under the muscle" is partly a misnomer, since the chest muscle does not cover the full lower breast. Most submuscular placements are really partial, which is the foundation dual plane builds on.
> - Placement does not fix a sizing problem. An implant too wide for your base width is too wide in any plane.
> - Animation deformity, the visible flexing during chest-muscle contraction, is the main downside of muscle-involving placements. It is avoided by subglandular placement and reduced but not eliminated by dual plane.
> - The recommendation comes from clinical assessment of tissue, skin, existing shape, lifestyle and goals, not from a chart.
The placement question comes up at almost every augmentation consultation, and patients usually arrive with some research done, often having found strong opinions in different directions. Over the muscle, under the muscle, dual plane: each has its uses, each has trade-offs, and the right answer for one patient is not always the right answer for another.

This guide walks through the three main options, what each does well, where each falls short, and the clinical factors that drive the recommendation. For an overview of the operation, see the [breast augmentation surgery](https://drturner.com.au/procedures/breast-body/breast-augmentation/) page, and for patients in Queensland, [breast augmentation in Brisbane](https://drturner.com.au/locations/brisbane/breast-augmentation/).

## The three main placement options

The implant has to sit somewhere in the breast, and there are three layers that can hold it: the breast tissue, the chest muscle (pectoralis major), or a combination. Each creates a different relationship between the implant and the surrounding tissue, which affects how the breast looks at rest, how it behaves during movement, and how it ages.

- **Subglandular (over the muscle):** the implant sits between the breast tissue and the chest muscle.
- **Submuscular (under the muscle):** the implant sits underneath the chest muscle.
- **Dual plane:** the upper portion sits under the muscle, the lower portion behind breast tissue alone.

Dual plane is used in the majority of modern augmentation cases. Subglandular and pure submuscular are used for specific clinical reasons, but they are the exception rather than the default, and the reasons why are worth understanding.

## Subglandular (over the muscle)

The implant sits between the breast tissue and the chest muscle, with no muscle covering it, so it takes the shape of the breast tissue draping over it. For patients with good native tissue volume, this can produce a soft, mobile result.

It works for patients with adequate native tissue to cover the implant, patients who want to avoid muscle-related considerations such as animation deformity during chest exercise, and some athletes whose chest-muscle work would distort a submuscular placement. Where it falls short is visible implant edges in thin-tissue patients, since there is no muscle to soften the upper pole; slightly higher capsular contracture rates than submuscular; more interference with screening mammograms, since an over-the-muscle implant can obscure more breast tissue; long-term ptosis, since the tissue and implant weight all bear on the skin envelope; and rippling visibility, particularly with thin tissue and saline implants, though this is less of an issue with modern cohesive silicone gel.

In contemporary practice, pure subglandular placement is used in a smaller proportion of cases than it was 15 to 20 years ago. The factors that pushed the field toward dual plane, including better long-term shape, lower contracture rates and better mammogram visibility, have made subglandular a narrower option than it once was, though it still has its place.

## Submuscular (under the muscle)

The implant sits underneath the pectoralis major, with the muscle covering the upper portion of the breast.

**What "under the muscle" really means** is worth clarifying, because the terminology misleads. Full submuscular coverage is not really anatomically achievable in augmentation, because the pectoralis major does not extend across the full lower pole; it originates from the chest wall and inserts along the upper arm but does not cover the inferior breast where the tissue meets the chest wall at the fold. So when patients ask about under-the-muscle placement, they are really asking about a partial submuscular placement, where the muscle covers the upper portion and the lower portion sits subglandular by anatomical necessity. This is the foundation dual plane builds on, which is why the two terms get used interchangeably even though they describe slightly different techniques.

The muscle provides extra coverage at the upper pole, softening the transition from chest to breast and reducing visible edges, with a more rounded upper pole particularly in thin-tissue patients. It works for patients with thin native tissue needing upper-pole coverage, patients seeking a conservative upper pole rather than visible projection, reconstructive scenarios after mastectomy, and patients where mammographic clarity matters. Where it falls short is animation deformity, meaning distortion when the chest muscle contracts during exercise, more common than with dual plane; a higher position initially with a longer settling period; limited lower-pole projection, since the muscle holds the lower implant against the chest wall; and a slightly more involved recovery, with more discomfort in the first one to two weeks. Pure submuscular is still used, but mostly in specific situations rather than as a default.

## Dual plane

The upper portion sits under the muscle and the lower portion behind breast tissue alone, so the tissue drapes over the lower pole while the muscle softens the upper pole. The combination produces a result typically described as more proportioned than either subglandular or pure submuscular, with a muscle-softened upper pole, lower-pole drape, and continuous rather than abrupt transitions.

It works for the majority of patients with adequate or moderate tissue coverage, patients with mild ptosis whose lower-pole tissue benefits from draping over the implant, patients seeking that balance of coverage and shape, and combined lift-with-implant surgery, where it is the standard choice. One clarification on ptosis: dual plane helps with mild lower-pole laxity or modest deflation, but it does not replace a lift when significant ptosis is present. Where the nipple has descended below the fold or there is substantial skin excess, a [breast lift with implants](https://drturner.com.au/procedures/breast-body/breast-lift-with-implants/) is the appropriate procedure, and the threshold between "dual plane handles it" and "you need a lift" is a clinical judgement rather than something to self-diagnose from photos, as covered in the [lift versus augmentation guide](https://drturner.com.au/blogs/breast-lift-vs-breast-augmentation/).

Where it falls short: some animation deformity remains, less than pure submuscular but still present in many patients; it requires more careful technique than the simpler subglandular approach, so surgeon experience matters; and extremely thin tissue may still benefit from a more conservative implant size or a different approach.

**The variations** matter, because dual plane is not a single technique. There are three levels differing in how much the muscle is released from the breast tissue at the lower pole. Dual Plane I involves minimal release, for tight, well-supported tissue with minimal laxity. Dual Plane II involves moderate release, for mild ptosis or some lower-pole laxity where the tissue needs to drape slightly. Dual Plane III involves extensive release, for more significant lower-pole laxity or a longer-bodied breast where the lower pole needs to expand more freely. The right variation depends on the relationship between nipple position, fold position, tissue distribution and skin elasticity, which is not decided until clinical examination is complete.

Dual plane is used in the majority of contemporary cases for good reason: it addresses the limitations of both pure subglandular and pure submuscular while keeping the advantages of each, and for most patients with reasonable tissue coverage it produces the most consistent long-term results.

## How placement interacts with size, profile and shape

Placement is not a standalone decision and is not a substitute for getting sizing right. An implant too wide for your base width remains too wide in any plane, and patients sometimes hope a particular placement will solve a sizing problem, which it will not.

In practice, implant width still needs to fit your natural base width, so placement is downstream of width fit rather than upstream of it; profile decisions sit alongside placement, since high, moderate and extra-high profiles project differently and that projection interacts with how the placement looks; larger implants stretch tissue more regardless of placement, so dual plane does not compensate for a size beyond what the envelope can support; round and anatomical implants both work in dual plane, though anatomical implants need closer pocket control and carry a small rotation risk; and surface choice is a separate decision influenced by contracture and BIA-ALCL considerations. How the dimensions fit together is covered in the [size, shape and profile guide](https://drturner.com.au/blogs/breast-implant-size-shape-profile-guide/) and the [round versus teardrop guide](https://drturner.com.au/blogs/round-vs-teardrop-anatomical-implants-choosing-best-breast-implant-shape/). Picking one element in isolation and hoping the rest sorts itself out does not produce consistent results.

## How the decision gets made

The recommendation comes from clinical assessment of several patient-specific factors rather than a chart. Native tissue coverage, since thicker tissue allows more options while thinner tissue pushes toward submuscular or dual plane for upper-pole cover. Skin quality and elasticity, since loose skin or stretch marks suggest the envelope may not support implant weight well. Existing breast shape, since mild ptosis often does well with dual plane while significant ptosis may need a lift component. Lifestyle and exercise, since chest-engaging activity is more compatible with subglandular than submuscular, with dual plane between the two. Personal and family history, including screening considerations and previous surgery. And what you are trying to achieve, since a conservative versus more projected look, and a mobile versus more stable feel, shape the choice as much as anatomy does.

The assessment is of the overall picture rather than any one factor: two patients with similar tissue coverage but different lifestyles can end up with different recommendations. The two-consultation framework gives time to discuss it and arrive at the right decision rather than one made on the spot.

## What about subfascial placement?

A fourth option is worth a brief mention. Subfascial placement positions the implant just beneath the fascia covering the chest muscle but above the muscle itself, giving a small amount of additional coverage compared with pure subglandular without the animation deformity of submuscular. In honest practice it is used relatively rarely, because the advantages over dual plane are modest and most surgeons who would consider it end up using dual plane instead, since the long-term outcomes are more predictable. It is a real option, but not a major part of contemporary practice.

## Animation deformity in more detail

This deserves a dedicated section as the most-discussed downside of muscle-involving placements. Animation deformity refers to the visible distortion when the chest muscle contracts over an implant beneath it, pulling on the implant and causing the breast to flex, dimple or move during certain activities: push-ups, bench press, dumbbell flies, some yoga poses such as chaturanga and plank variations, pectoral flexing, and occasionally some arm movements.

Most patients rarely notice it in everyday life, since it is most visible during activities that specifically engage the chest muscle. For patients whose lifestyle does not involve significant chest work it is often a non-issue, while for regular weight trainers or high-impact athletes it can be more noticeable. It is only present during muscle contraction, returning to baseline when the muscle relaxes. Managing it: subglandular placement avoids it entirely, which is one of its genuine advantages for patients whose lifestyle makes muscle-involving placement impractical; dual plane reduces it compared with pure submuscular but does not eliminate it; smaller implants tend to show less than larger ones; and careful muscle release at appropriate levels reduces but does not eliminate it. For patients deeply concerned about it, the consultation includes whether subglandular placement suits their anatomy and goals.

## Frequently asked questions

**What is the most common breast implant placement used today?**

Dual plane placement is used in the majority of contemporary augmentation cases, placing the upper portion of the implant under the chest muscle for upper-pole coverage while the lower portion sits behind breast tissue for lower-pole drape. Most patients with reasonable tissue coverage are good candidates, though specific clinical situations may call for subglandular or pure submuscular placement instead.

**Is dual plane the same as under the muscle?**

Not quite, and the distinction matters. "Under the muscle" is often used loosely to mean any placement involving the pectoralis major, but full submuscular coverage is not really achievable, because the muscle does not extend across the full lower pole. Most under-the-muscle placements are in reality partial submuscular, where the muscle covers the upper portion and the lower portion sits subglandular by necessity. Dual plane is the refined, deliberate version, with controlled muscle release at the lower edge so the lower implant pole sits behind breast tissue cleanly.

**Can I have implants placed over the muscle?**

Yes, in appropriate situations. Subglandular placement suits patients with adequate native tissue who want to avoid muscle-related considerations like animation deformity during exercise. The trade-offs include slightly higher capsular contracture rates, more visible implant edges in thin-tissue patients, and some interference with mammographic screening compared with submuscular placement.

**What is animation deformity, and is it permanent?**

It is the visible distortion that can occur when the chest muscle contracts over an implant placed beneath it, during activities such as push-ups or bench press. It is only present during muscle contraction and returns to baseline when the muscle relaxes, so it is not a permanent deformity at rest. Subglandular placement avoids it entirely, and dual plane reduces but does not eliminate it compared with pure submuscular placement.

**Which placement lasts the longest?**

All three can produce durable results, and the factors affecting long-term outcome are more about implant care, weight stability, pregnancy, breastfeeding and supportive bra wear than about which placement was used. Dual plane and submuscular tend to preserve upper-pole shape better over time than subglandular, which is one reason they are more commonly used. The evidence on how long implants last is covered in the [implant lifespan guide](https://drturner.com.au/blogs/what-is-the-lifespan-of-breast-implants/).

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS). A GP referral is required before an initial surgical consultation under the current Medical Board of Australia framework. To discuss which placement suits your anatomy, lifestyle and goals, [contact the practice](https://drturner.com.au/contact-us/) to arrange a consultation.