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Breast Augmentation Under The Muscle Vs. Over The Muscle

Breast augmentation continues to be one of the most popular aesthetic surgeries in our practice.  At the time of your consultation, you will learn much more about breast augmentation and the results that can be tailored to your goals.  Today we want to consider one of the basic issues of breast augmentation that is the placement of the implants themselves.  In simple terms, breast augmentation involves placement of breast implants into the breasts to improve size, shape and contour of the breasts.  There are different types of implants that can meet a patient’s needs.  There are different surgical methods that will need to be considered as well.

One of the surgical methods involves placement of implants relative to the pectoralis (chest wall) muscle, and the mammary gland, breast tissue.   Two options to consider are placement of the implants in the submuscular plane vs in the subglandular plane.  In the submuscular plane, the implant is placed beneath the pectoralis muscle as well as the mammary tissue itself.  The implant could be placed completely underneath the muscle, or partially underneath the muscle, depending upon the patient’s needs and goals of surgery.

The benefits of submuscular placement, in my opinion, include a more long term, natural result, a more aesthetically pleasing result and less risk for rippling or visibility of the shell of the implant.  In my opinion, implants placed underneath the muscle have a lower risk for capsular contracture, a painful complication where scar tissue develops.  Implants underneath the muscle may make mammogram interpretation easier.  The disadvantage of placing the implant underneath the muscle is that over time the pectoralis muscle may continue to contract and push the implant slightly laterally.  If a patient is extremely active, we do have to worry about implant movement with pectoralis muscle contracture.  Therefore, in some individuals we consider a subglandular position.

Breast implants that are placed in the subglandular position can often be used to achieve fuller or tighter cleavage.  In addition, patients will have less swelling, less pain and recover faster.  The disadvantages of placement of breast implants underneath breast tissue only, in my opinion, have to do with increased inferior migration of the implants over time, gravity pulling everything south, greater palpability of the shell of the implant, greater risk for rippling, especially in a thin individual, greater risk for capsular contracture, and, potentially, a greater risk of leakage.

My general preference is to place implants in the submuscular position.  Over the long term, I think that gives a better result.  However, there are certain situations where I will recommend a subglandular position.  At the time of your consult, this would be reviewed with you and a more precise surgical plan established.

If you have any questions about breast augmentation, please don’t hesitate to contact the office.

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