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Best Breast Implant Placement – Over the Muscle, Under the Muscle or Dual Plane?

One of the most important aspects of breast augmentation is the placement of your breast implant. Although it’s not something most patients think about, the placement of your breast implant has a major influence on the results of the procedure. Let’s discuss several placement options and help you find out which one is the best.

What are the breast implant placement options?

Most patients aren’t even aware there are several options for the placement of breast implants. The most common breast implant pocket placement options here are subglandular placement (over the muscle), submuscular placement (under the muscle) and a combination called Dual plane placement.

1. Subglandular Implant placement

Subglandular, (subfascial) or over the muscle, placement is a technique in which a breast implant is positioned between the existing breast tissue areas and the chest muscle. The main objective of this method is to ensure the implant lies below the breast’s glands.

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Subglandular or ‘Over the Muscle Implant’ Placement

Who is ideal for over the muscle – subglandular?

Women with a higher amount of natural breast tissue (B cup or larger) are the most suitable candidates for this type of implant placement. Large amount of breast tissue provides better coverage for the implant and produces a more pronounced and rounded look (some women love it, others don’t).

If you have enough soft tissue coverage around your cleavage area, this placement will likely be the best option. The breast implant will be placed between the breast tissue and the pectoralis muscle.

Pros of over the muscle placement

The main advantage of over-the-muscle implant placement is less movement of the implants or breast animation during physical activity. Also, it’s a relatively easier procedure than other types of implant placement. Surgeons can also use larger implants with subglandular placement.

Patients who undergo breast augmentation with this technique usually have less discomfort and faster recovery after the procedure. They recover faster because the chest muscle is undisturbed during the procedure. Swelling after breast augmentation subsides quickly, thus allowing breasts to “settle” to natural form and shape faster. When flexing the chest muscle, there is no chance of distorting the implant.

In summary – some of the benefits of subglandular placement are:
•   Rapid recovery
•   Enhanced breast cleavage
•   Reduced lateral malposition (widening of cleavage)
•   Improved shape with constricted breast or breast ptosis
•   Minimal risk of breast animation

Cons of over the muscle

When it comes to disadvantages, the look of your implants may seem more artificial with subglandular placement, particularly if the skin and breast tissue are of poor quality. The technique also increases the chance of visible implant rippling, especially in women with less breast tissue. That’s why this is not a suitable implant placement if you don’t have enough breast tissue. However in women with adequate fat reserves, fat transfer to the breast in combination with a breast implant – a Hybrid BA Breast Augmentation (implant & own fat) may reduce the chance of these complications

Mammograms readings may also be less clear in patients who’ve undergone breast augmentation with the over-the-muscle implant placement method.

A complication called Capsular contracture is more prevalent in patients whose implants are placed over the muscle. Capsular contracture is when the body reacts to a breast implant in a way that can cause pain and distort the shape of the implant.

2. Submuscular Implant placement

Submuscular, or under the muscle, placement involves placing breast implant partially under your pectoralis major muscle, a thick fan-shaped muscle located at the chest.

In this procedure, the surgeon partly detaches the pectoralis major muscle from the bottom along the ribs. Then, the implant is placed right underneath. That being said, the pectoralis major is a relatively short muscle and is unable to cover the entire surface of the implant. It can only cover the top half of the implant, while your breast tissue covers the bottom half.

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Submuscular or ‘Under the Muscle’ Implant Placement

Who is ideal for under the muscle or submuscular placement?

The submuscular placement is a good option for women with a smaller amount of natural breast tissue (Smaller bra cup sizes). In women with little breast tissue, the muscle provides greater coverage over the implant. This will also lead to more natural results.

Pros of under the muscle placement

Your breasts have a more natural look, a smoother shape, and more tissue coverage. The risk of capsular contracture is lower in women who’ve undergone under the muscle implant placement. The chance of visible rippling is low with this approach.

Mammograms also tend to be clearer in patients with submuscular placement because the implant is “out of the way”.

In Summary, some of the benefits of sub muscular placement are:
•   Natural upper pole of the breast
•   Reduced dropping (inferior malposition)
•   Less interference with breast imaging (mammogram)
•   Reduced visibility, palpability and rippling

Cons of under the muscle

Generally speaking, this technique is associated with slightly more discomfort and a longer recovery period, as well as temporary loss of strength in chest muscle. That happens because this placement method involves incisions to the muscle. Since swelling takes longer to subside, it may take longer for breasts to settle into their natural form and shape.

Animation deformity is yet another uncommon but possible complication. Animation deformity happens when the implant moves upward and toward the axilla (an armpit) when a patient flexes the pectoral muscle, e.g. during the exercise. This complication is rare but possible and more likely than in completely subglandular technique. The risk of rupture may also increase.

3. Dual plane Implant Placement

A dual-plane, often referred to as partial submuscular placement, is a technique where your breast implant is partly behind the pectoralis muscle and partly behind the breast tissue. In this case, the layers of the breast from external to internal level are the skin, breast tissue, pectoralis muscle, and ribs.

As you can see, dual plane placement combines both subglandular and submuscular implant placement. To perform this procedure, a surgeon needs to detach the lower origin of the pectoralis muscle from the chest wall and separate it from the bottom part of the breast tissue. As a result, the muscle can slightly slide upward. When the implant is positioned, one part of it is covered by the muscle and the other by breast tissue. You probably noticed the dual plane is very similar to submuscular placement but an improved version.

Who is ideal for Dual Plane Implant Placement?

This involves the breast implant is placed between the rib cage and pectoralis muscle. With the customized dual plane technique, only the upper half of the breast implant is behind the pectoralis muscle and the lower half of the implant is directly behind the breast tissue. It is the ideal choice in women who have thin or very little breast tissue, as the muscle enhances coverage of the upper area of the breast implant in the cleavage area.

This procedure is particularly useful for the correction of breast sagging or ptosis, which tends to occur after having children, breastfeeding, losing weight, or due to the natural aging process. In women with saggy breasts, dual-plane allows placement of the implant lower to fill the bottom pole of the breast and produce a lifted appearance. Bear in mind dual-plane doesn’t eliminate the need for mastopexy (breast lifting) procedure in cases when sagginess is moderate to severe, but it can help with mild cases.

Besides women with low-grade breast droop, dual-plane is suitable for those desiring breasts with more natural fullness. Additionally, women with tuberous breasts may also benefit from this technique. Tuberous breasts are misshapen breasts caused by a congenital abnormality that restricts normal breast development during puberty.

Pros of Dual Plane placement

The biggest advantage here is that the technique uses more soft tissue to camouflage or hide the underlying implants. For that reason, the implant-breast transition is smoother, and the breast shape is enhanced, which results in a more natural appearance. The risk of capsular contracture is also lower with this approach. Dual plane makes it easier to read mammograms.

Cons of Dual Plan

Patients may have more discomfort and slower recovery after dual-plane surgery, but keep in mind it’s just temporary and for your longer-term benefit. The technique also carries some risk of animation deformity (especially in bodybuilders, gymnasts and athletes). If the muscle is not released to a correct specific degree, it can cause a high-riding implant and a droopy breast deformity or snoopy nose complication .

As with submuscular placement a wider cleavage gap can be an issue for some women, this can be offset by fat transfer to the medial cleavage to create more aesthetic narrow cleavage lines with a hybrid BA procedure.

Which implant placement is the best for me?

The answer to this question is “it depends” because the choice of under-skin placement of breast implants is based on several factors. These include:

  • Your Medical and Health history
  • Your Body type
  • Your Existing breast tissue
  • Your selected Implant type and size
  • Your Goals and expectations regarding the aesthetic results of the procedure

The best way to find out which implant placement is the best for you is to schedule a consultation with Dr Scott Turner. During the consultation, he will perform a physical exam and ask a series of questions regarding your expectations and goals. Then, you will both agree on the most suitable approach for the best results.

When it comes to implant placement, there is no “one size fits all” rule. Not all breasts are equal. What’s beneficial for a woman with a larger amount of breast tissue may not be a good option for someone with less breast tissue or a person with breast sagginess. The first woman would benefit more from the subglandular placement, the second one from submuscular (today dual plane is a preferred option), and either one from the dual plane.

That being said, several other factors play a role here, and the choice of an implant placement depends on them too. That’s exactly why it’s crucial to schedule a consultation with an experienced and reputable surgeon like Dr Turner, who will recommend the best placement option based on the all factors evaluated.

It would be impossible to say one method is better than the others. Each method is the best for different women and types of breasts. However, it’s useful to mention that a combination of subglandular and submuscular approaches, i.e. dual plane is now one of the preferred techniques for many surgeons. There also now modified and improved dual place approaches.

Implant Placement FAQs – Questions people ask about Breast Implant placement

Is it better to go under or over the muscle?

  • The answer to this question depends on several factors, including the size of your breast tissue. Women with a larger amount of breast tissue could benefit more from the over-the-muscle approach, while under-the-muscle (and more frequently dual-plane) are usually recommended for women with a lower amount of breast tissue. The decision here is up to your surgeon, who evaluates several factors and collaborates with you to determine the best technique for desired results.

Do implants under the muscle look smaller?

  • The implant under the muscle may look smaller but also more natural or less augmented. Women who are concerned about implants looking smaller under the muscle may want to go up one size. Of course, this is one of many subjects discussed during patient consultations.

How do you tell if implants are under the muscle?

  • There’s a quick way to find out. Place your hands on the hips and press inwards. This will contract your chest muscle. If the implants are under the muscle, the top of the implant will flatten. Implants on top of the muscle won’t become flat because they aren’t squeezed by it.

Can over the muscle implants look natural?

  • In very thin women, there is usually not enough tissue coverage for a natural look. Over-the-muscle implants tend to look more natural in women with bigger breast tissue.

How many ccs of volume do you lose under the muscle?

  • Placing implants under the muscle leads to about 50cc loss of volume. What this means is that if you want 300 sizer breasts, you may need to opt for a 350 implant to achieve that result.

How painful are breast implants under the muscle?

  • Under-the-muscle implants tend to be more painful due to incisions on the muscle. The pain is the most intense one to three days after the surgery.

How long do breast implants under the muscle last?

Will under the muscle implants get bigger?

  • Breast implants don’t change size. Breasts change shape. What seems like an enlargement to some women, it’s just breasts healing and settling down.

Will my implants look bigger if I lose weight?

  • Implants may look larger on a thinner body and smaller frame. But, keep in mind they can’t actually become bigger.

What implants look the most natural?

  • Several breast implant options are available today, but silicone implants tend to produce the most natural-looking and natural-feeling breasts.

Why do my implants look so small?

  • Many women find their implants look smaller after the procedure. That happens due to swelling and the inflammatory process. As you recover, breasts will settle, and you will notice a larger and more natural look.

Can you go bigger after breast augmentation?

  • You can; once the chest cavity has fully adapted to an implant. If you plan to go bigger, you will need to schedule an appointment and consult your surgeon.

How soon can I get bigger implants?

  • The waiting period is usually six to 12 months.

Summary

Several breast implant placement options are available. Each option is more suitable for a specific group of patients. Many surgeons opt for a combination of over-and under-the-muscle called a dual plane. It would be difficult to say which placement method is more suitable for you. Various factors are involved. For that reason, the best thing to do is to schedule an appointment and consult Dr. Turner.

Further Reading – Medical References on Implant placement

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