Once you’ve made the exciting decision to have breast implant surgery for augmentation or reconstruction, your decision-making has only begun! One of the other big considerations you have before your surgery  is where the implant will be placed. There are three options: over, partially under, or fully under the pectoral muscle. While there are advantages and disadvantages to each option, be sure to ask your surgeon for his professional opinion about which will suit you and your personal needs.

Above the Muscle

Subglandular implants are placed above the pectoral muscle, functioning as a barrier between breast tissue and the muscle on the wall of the chest. The resulting look can be rounder than natural breasts.

Pros:

  • Relatively easy for surgeons to place and access, which is useful for post-surgery access.
  • Normally less pain following surgery because the muscle has not been cut or disturbed.
  • Easier to insert larger implants.
  • Easier to create cleavage.

Cons:

  • Can obstruct mammograms by as much as 40%.
  • Elevated risk of capsular contracture
  • The edges of the implant may be visible or detectable through touch (especially if the woman selects implants with textured shells).
  • Increased possibility of “bottoming out,” when the crease of the breast lowers and the nipple points upwards.
  • May increase a woman’s difficulty with breastfeeding.

Partially Below the Muscle

With partial submuscular placement, the implant will be partially covered by the muscle at the top, and come into contact with breast tissue at the bottom.  This placement is commonly done with the crease or nipple incisions.

Pros:

  • Does not usually interfere with mammograms.
  • Implant edges are less visible.
  • Final look appears more natural.
  • Reduced risk of capsular contracture is reduced.

Cons:

  • More difficult to perform than subglandular implants
  • Often more pain following surgery.
  • Higher risk of bottoming out than the submuscular technique.

Fully Below the Muscle

The submuscular method, places the implant completely below the patient’s pectoral muscle; it does not come into contact with breast tissues. Unlike the partial submuscular technique, connecting muscle at the bottom is left intact, helping to support the breast and often preventing bottoming out.  Full under-muscle placement is best accomplished through the transaxillary (armpit) incision.

Pros:

  • May increase breastfeeding chances.
  • Greatly reduces likelihood of bottoming out and capsular contracture.
  • Creates a natural look.
  • Decreased possibility of interfering with mammography.
  • Reduced visibility of implant.

Cons:

  • More challenging procedure.
  • More pain and/or discomfort for the patient after surgery.
  • Increased discomfort until the muscle bridge that supports the bottom (the “support fascia”) stretches to accommodate the new implant.