Implant Placement Options

In breast augmentation, the question arises over the best location to place the implant… above or below the pectoralis major muscle. Both are used in a variety of breast surgeries depending on the goals and physical presentation of the patient. Let’s take a look at the pros and cons of both and when one method might be preferred over the other.

Under the muscle, or sub-pectoral, placement is probably the most common here in the United States, although in Brazil this is not the case! In this country we have a tendency to use larger implants and under the muscle placement usually gives a somewhat more “Natural” look. The pectoralis muscle covers the upper part of the implant making the edge less visible, less “implant-ish”. In theory, there is less interruption with mammogram and there seems to be a lower rate of hardening of the breast capsule or less breast capsular contracture.  In the first few days after surgery, there is probably a bit more discomfort than above the muscle, but this difference goes away in time. Now we have the habit of saying that these implants are under the muscle but in the majority of cases they are “mostly” below and a “little” above. This can be called “Dual Plane” as well. The reason for this is that the Pectoralis muscle, in most women, sits just a bit too high to fit the breast implant completely underneath, and it has to be released at the bottom to allow the implant to settle in a more proportional and natural location.  And because the breast implant peeks out just a bit from underneath the pectoralis muscle, it is usually more easily felt along the lower edge. Also, many women discover after healing and returning to the gym, what is described as the “animation effect”, where contraction of the pectoralis muscle presses on the breast implant.

Over the muscle was probably the most common method 30 years ago and as opposed to the bit more natural look of under the muscle, it gives more of what I call the “Wow”  look. In many cases the upper edge of the breast implant is much more visible, and can give more of a round, implant look to the breast. The recovery from surgery is probably a bit easier and is not prone to the animation effect described above, so that for serious body-building and fitness competitors, who may find themselves flexing on stage wearing a postage-stamp sized swimsuit, this may be a better choice! However, one drawback for some women with a fairly lean build, or women with very little breast tissue, is that the breast implant can be much more visible and any wrinkles, ripples or folds that the breast implant may develop might be more easily seen through the skin. So for women that already have a bit of breast tissue and are not choosing a very big implant, this may be a viable alternative for them. Another issue is that it is the common wisdom by most surgeons that going above the muscle can have a bit more tendency to develop capsular contracture or hardening of the breast than below the muscle, however, studies are always ongoing to determine this more precisely.

As with almost anything, there are pros and cons to above the muscle vs. below the muscle placement of breast implants and this is just one part of the discussion to have between a Board Certified Plastic Surgeon and any potential patient.

For more informationon breast implant placement, contact our Phoenix breast surgeon, Dr. Corey for a personalized evaluation.  Serving the areas of Phoenix, Scottsdale, Gilbert, Tempe, Mesa and Chandler.