The Location of Your Implant

Implant location is an important consideration for breast augmentation. Breast implants may be placed on top of the muscle or under the muscle. When placed “on top of the muscle” they are placed between the pectoralis major muscle and the breast gland. When placed “under the muscle” they are placed under the pectoralis major muscle. There are actually several variations of being placed “under the muscle”. One method is to attempt to obtain total muscle coverage (total submuscular) by attempting to recruit adjacent muscles to cover the implant. Another is to cover it with the pectoralis major without releasing it from the ribs near the bottom of the breast (partial submuscular). Another is to cover the implant with the pectoralis major muscle and release the lower portion from the ribs to allow a certain amount of interface between the implant and the breast gland (dual plane). The pros and cons of each method are shown below.

IMPLANT LOCATION: ABOVE MUSCLE

Advantages
1. Better control of breast shape.
2. May have less pain and faster recovery.
3. No distortion with muscle contraction.
4. Better control of the inframammary fold.
Disadvantages
1. More likely to feel and see implant edge.
2. More interference with mammogram.
3. Increased risk of capsular contracture (firmness).
4. More likely to see implant wrinkling.
5. More likely to interfere with nipple sensation.

IMPLANT LOCATION: PARTIAL SUBMUSCULAR

Advantages
1. Less likely to feel and see implant edge.
2. Less interference with mammogram.
3. Decreased risk of capsular contracture (firmness).
4. Less likely to see implant wrinkling.
5. Less likely to interfere with nipple sensation.
Disadvantages
1. Eventually displaces towards the side, widening cleavage over time.
2. Less fullness in upper inner breast.
3. May have more pain and longer recovery.
4. Distortion with muscle contraction.
5. Less control of the inframammary fold.

TOTAL SUBMUSCULAR

Advantages
1. Same as Partial Submuscular, plus:
2. Possible temporary increased soft tissue coverage over lower outer breast.
Disadvantages
1. Same as Partial Submuscular, plus:
2. Increased risk of upper implant displacement.
3. Longer surgery time.
4. Most pain and longest recovery time.
5. Least control of inframammary fold.

DUAL PLANE (Preferred technique)

Advantages
1. Less likely to feel and see implant edge in upper and inner breast.
2. Less interference with mammogram.
3. Decreased risk of capsular contracture (firmness).
4. Less likely to see implant wrinkling.
5. Less likely to interfere with nipple sensation.
6. Better control of lower breast shape.
7. Less pain and faster recovery, identical to submuscular technique.
8. Better control of the inframammary fold.
9. Minimizes displacement towards the side, preserves cleavage.
10. More fullness in upper inner breast than partial submuscular.
11. Reduced distortion with muscle contraction.
12. Less control of the inframammary fold.
13. In my opinion, the most natural shape
Disadvantages
1. More likely to feel implant at lower breast.