Where Are Breast Implants Placed with Respect to the Breast?

Beverly Hills women who are considering breast augmentation in Los Angeles have many important issues to consider. One of such important decisions is the choice of placement of breast implants by your plastic surgeon, either under or over the Pectoralis Major or chest muscle.

Subpectoral Breast Implant Placement: “Under the Muscle”

In Sub-pectoral positioning, the breast implant is placed under the Pectoralis Major muscle and directly over the rib cage. In this case, although most of the implant is covered by muscle, the lower part of it is not. This is preferred by many Board Certified Plastic Surgeons since it creates a more tear drop and natural breast shape. On the other hand, some surgeons prefer a “full submuscular” breast implant placement, where the breast implant is entirely covered by the chest muscles. Another disadvantage of submuscular placement is that flexing of chest muscles during exercise can contract the implants or push them in and out of place. Furthermore, the breasts will have a flatter shape, and at times will show a double-bubble deformity, where the periphery of the implant appears separate from the breast.

The main advantages of submuscular or Subpectoral breast implant placement as compared to subglandular placement are:

1. Lower Risk of Capsular Contracture: (3% vs. 30%) The body builds a scar capsule around any foreign material including a breast implant. This capsule is usually very thin and soft in the submuscular/subpectoral pocket. On the other hand this capsule can become very hard and thick in the subglandular pocket causing the breast implants to become very hard and spherical. In severe cases, this can cause much pain and deformity, requiring removal of the breast implant from the subglandular pocket and placing them in the subpectoral/submuscular pocket.

2. Less Sagging of Breasts: The Pectoralis Muscle tends to hold the breast implants up and prevents them from sagging.

3. Less Visible or Palpable Rippling: Although all saline breast implants do ripple, their placement under the muscle will better camouflage them.

4. Better protection of the breast implants: In case of the need to perform breast biopsy or surgery on the breasts.

5. More Natural Shape: Pectoralis Muscle pads the upper pole of the breast implants, therefore, making the upper breast slope appear more smooth and gradual.

6. Less Obstruction of the Breast Tissue with Mammogram. Placement of the breast implants away from the breast tissue and under the muscle interferes less with mammography and breast examination.

Disadvantages of submuscular or subpectoral breast implant placement as compared to subglandular placement is:

1. Breast Implants take longer to drop or settle after surgery.

2. Possible creation of a Double-Bubble deformity in sagging or ptotic breasts. Because breast implants are held up by the muscles, the sagging breast tissue can hang over the implant as a separate entity. This can give the appearance of a double-bubble. This can be avoided by lifting the sagging breast tissue and centering it on the breast implant.

3. More post-operative pain. As a rule, the difference in the degree of pain is insignificant.