Breast Implants: Over vs. Under the Muscle – A Plastic Surgeon’s Perspective

Breast augmentation is among the most frequently performed cosmetic surgeries globally, with countless women seeking this procedure each year to enhance their self-confidence and body contour. The procedure involves inserting breast implants to add volume, improve symmetry, and boost the overall appearance of the breasts. A critical decision during this process is the placement of these implants – over or under the muscle. The surgeon’s choice significantly impacts the final results, recovery process, and potential complications.

Understanding Breast Implants

Breast implants are essentially medical devices that contain a silicone shell filled either with silicone gel or saline solution. They can come in a variety of shapes and sizes, allowing for customization to each patient’s individual needs and body type. The choice between saline and silicone, and the size and shape of the implant, are all crucial decisions, but the placement of these implants is equally important.

Over the Muscle vs. Under the Muscle

Implants can be placed either in a subglandular position (over the muscle), or a submuscular position (under the muscle).

1. Subglandular placement: Also known as the “over the muscle” approach, the implant is positioned between the breast tissue and the chest muscle. This method often involves a simpler surgical procedure and a quicker recovery period. It can provide a more natural movement and may be preferable for women with a good amount of natural breast tissue.
2. Submuscular placement: In this “under the muscle” method, the implant is placed beneath the pectoralis major muscle. This approach is typically recommended for women with little natural breast tissue, as the muscle provides an additional layer of coverage for the implant, resulting in a more natural-looking contour. It may also reduce the risk of complications such as capsular contracture and implant rippling.

Key Benefits of Above or Below the Muscle

Breast Implant Above the Muscle:  
• A more natural look and feel
• Appearance of fuller upper breasts
• Easier to place the implant near the cleavage  

Breast Implant Below the Muscle:  
• A more natural shape and look for the augmented breast
• Additional tissue coverage resulting in less visible rippling
• Implants will not be visible when bending down or reaching up
• Implants can move with the muscle, creating the appearance of a more natural breast shape
• Breasts may appear less full on the upper part.

Factors Influencing the Surgeon’s Decision

Several factors guide a plastic surgeon’s decision on the appropriate placement of the breast implants:

• Patient’s Anatomy: The patient’s body type, the amount of existing breast tissue, the thickness of the skin, and the chest wall’s shape play pivotal roles in deciding the placement of the implants.
• Desired Aesthetic Outcome: The patient’s expectations and desired look also influence this decision. If the goal is a more rounded, prominent look, a surgeon may opt for over the muscle placement. Conversely, for a subtler, more natural appearance, under the muscle placement might be chosen.
• Lifestyle and Physical Activity: For women who frequently engage in strenuous chest exercises, submuscular placement may be preferred as it reduces the risk of implant displacement.
• Implant Type and Size: Larger implants or those with a more teardrop shape may be better suited to submuscular placement to promote a more natural appearance.
• Risk of Complications: Each method comes with its own set of potential complications. The under the muscle approach tends to reduce the risk of capsular contracture and implant rippling but may involve a longer recovery period.

If you have a preferred surgery date, do not wait until it’s too late

New Age Medical Aesthetics & Plastic Surgery is a very active aesthetic practice. If you have a preferred surgery date, do not wait until it’s too late. Call (613) 595-1880 to reserve your consultation. Our Patient Coordinators are happy to help you.