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Over vs Under the Muscle: What Breast Implant Placement Technique Is Best?
Dec 26, 2023

There are different techniques for doing breast augmentation. Patients who are considering augmentation may have heard about the advantages of over the muscle vs. under breast implant placement. There is no one procedure that is best for everyone. There are pros and cons to both methods, and the “right” procedure is different for each patient. We will discuss why one might work better than the other for certain women.

breast enhancement surgery

Under the Muscle Implants vs. Over in Breast Augmentation

When most women begin to consider breast implants, it’s because they want fuller, rounder breasts. Soft tissue naturally plumps the breast and provides its pliable form, but sometimes weight loss, breast feeding, or gravity changes the volume and shape of soft tissue. The goal of implants is to bring fullness back to the breasts. 

The pectoralis muscle lies under the breast’s soft tissue. In women who have a relatively thin (less than ½ inch) and flexible pectoralis muscle, we can place breast implants using one of three methods:

  • Subglandular or “prepectoral placement,” also known as over the muscle. In this method, we keep the muscle in place against the chest wall, then place the implant over it and cover it with soft tissue and skin.
  • Submuscular or under the muscle, which is when we tuck the implant under the chest muscles. 
  • Dual-plane placement is a combination of both approaches. We insert the top of the implant under the pectoralis muscle, while the bottom of it is only covered by soft tissue and skin.

breast implant placement

Pros of Subglandular Placement

Placing implants over the pectoralis muscle allows for: 

Larger implants. Soft tissue and skin are capable of stretching more than muscle. This allows for patients to increase their breast size significantly.

Predictable results. Over the muscle vs under breast implant placement allows for soft tissue and skin to mold to the outline of the implant, resulting in a more predictable breast contour.

An easier recovery. Subglandular placement can be done via an incision in the umbilicus (belly button), which can greatly reduce scarring on the breasts. And since the muscle is not cut, this method poses a lower risk of injuring the muscle or affecting its strength.  

Greater visibility of breast tissue for mammograms. In some cases, having breast implants on top of the muscle makes it easier for imaging tests to see a clear picture. 

Women who have large chest muscles are also candidates for over the muscle implants, since placing the implants under the muscle could cause the implants to move when the chest muscles contract. 

Cons of Subglandular Placement

Subglandular placement is not for everyone, especially patients who have minimal natural soft tissue. When soft tissue is stretched around the implant, it can sometimes harden and form fibrous tissue, a process known as “capsular contracture.” The capsule around the implant contracts, making it become thick and puckered like a scar. This can be painful and cause the implant to look deformed. 

And since soft tissue is more pliant than muscle, capsular contracture makes the implant more apparent. The result is a wrinkly or wavy appearance known as “rippling” on the lateral surface of the breast. Women who have a limited amount of overlying natural breast tissue are more likely to experience rippling, so we usually don’t recommend placing implants over the muscle for women who are very slim, or cancer survivors who have had an extensive resection. 

Pros and Cons of Under the Muscle Implants

Positioning the implant under the pectoralis involves detaching the muscle and inserting the breast implant underneath it. This technique offers multiple advantages, but there are also drawbacks you should be aware of.

Pros of Submuscular Placement

Capsular contracture and rippling are not concerns in submuscular placement since the implant is less visible under the muscle. This is why we often recommend that patients with minimal breast tissue have under the muscle implants vs over in breast augmentation. Placing implants under the pectoralis muscle also achieves a natural, proportionate look since there is a smooth transition from the chest wall to the implant. 

Cons of Submuscular Placement

Drawbacks to implants under the muscle include:

Smaller size potential. The pectoralis muscle does not extend as far as soft tissue can, which limits the size of the implant. 

Increased postoperative pain. Surgically moving the pectoralis muscle to place the implant behind it can cause more pain when recovering.  

Difficulty attaining cleavage for some patients. Because the muscle must be thinned near the breastbone to achieve cleavage, there is an increased risk of eventually developing symmastia, which is when implants merge in the midline of the body, resulting in a “uniboob.” Surgical procedures can be performed to restore the inner contour of the breast and eliminate this result.

Dual Plane Placement

In “dual-plane” placement, only the upper half of the implant is behind the muscle while the bottom half sits on top of the muscle, directly under the soft tissue. This is sometimes recommended if the pectoralis is not large enough to cover the implant completely. It’s also a good option for women with moderate soft tissue who want natural looking results. 

The downside to dual plane placement is a greater level of noticeable movement or “animation” than under the muscle placement.

uniboob

RELATED: What Is A Uniboob? Symmastia Explained

Which is Better: Over the Muscle vs Under Breast Implant Placement?

As you can see, there is no black and white answer to that question. The best placement for each patient depends on their body type, previous surgeries, and the desired aesthetic outcome of their augmentation. 

We take pride in our patients’ satisfaction and will discuss these details during your initial breast implant consultation. After assessing your breast’s natural form and reviewing any previous surgeries, we will explain the range of surgical procedures available to you that can achieve your desired results. We will then go over the surgery timeline, recovery expectations, and potential risks. 

Additional Reading and References

About the Author

Dr. Patrick J. Greaney Jr., MD, FACS

Dr. Patrick J. Greaney Jr., MD, FACS

Dr. Greaney is a Bergen County native and was Valedictorian at Ramapo High School locally. After being accepted to Jefferson’s six-year accelerated premedical-medical program in cooperation with Pennsylvania State University out of high school, Dr. Greaney continued his full general surgery training at Thomas Jefferson University Hospital in Philadelphia. He then went on to complete advanced training in burn reconstruction , plastic surgery and microsurgery in New York City at New York Presbyterian Hospital/Weill-Cornell, Montefiore Medical Center, and NYU Langone Medical Center respectively. Dr. Greaney then became an Assistant Professor at his alma mater (Jefferson) where he practiced for nine years, founded Jefferson’s DIEP breast microsurgical program, and was named Top Doctor in Philadelphia from 2017- 2020 before returning to New Jersey. Dr. Greaney is board certified by both the American Board of Surgery and the American Board of Plastic Surgery. Dr. Greaney resides with his wife and two daughters in Bergen County, NJ.

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