shutterstock_239306164When planning breast augmentation surgery, there are several important decisions to make: implant size, implant filling, incision location and implant placement. The implants can be placed either over the chest muscle (or the pectoralis major muscle, which is a fan-shaped muscle located over the rib cage) or below it. Here, Los Angeles plastic surgeon Dr. George Sanders shares his thoughts about the “over vs. under” debate.

Under the Muscle

There are a few advantages of placing implants under the chest muscle (this approach is called the “submuscular” placement). One is that the muscle offers implant coverage, which is important especially in women with very little native breast tissue. Without adequate “padding,” implants can look obvious on the chest and be vulnerable to rippling or causing the skin above the implant to look “wavy.”

Implants placed under the muscle receive a little bit of pressure from the muscle that gives the breast a natural sloped appearance (with more fullness on the bottom of the implant); this is considered the more anatomically correct breast shape.

Another advantage to placing implants under the muscle is that some radiologists believe it is easier to take and read mammograms.

Capsular contracture is also less of a risk with submuscular placement.

However, placing implants under the muscle does have a few drawbacks. For example, the recovery from surgery can be longer and slightly more uncomfortable than the surgery to place implants over the muscle. The implants must be positioned higher on the chest, which may not look as natural. And, with this placement there is the potential for the implant to interfere or distort during certain chest exercises — although this is mostly limited to bodybuilders or other heavy lifters.

Over the Muscle

Despite the established advantages of placing implants underneath the muscle, plastic surgeons do occasionally place implants over the muscle (this approach is called the “subglandular” placement). Most of the time, it is for women that have enough natural breast tissue (at least a “B” cup size) to camouflage the implant and therefore do not need the muscle’s coverage. Or, subglandular placement may be recommended to bodybuilders that have overdeveloped chest muscles that can potentially affect the look of the implant when flexed.

Another advantage to placing implants over the muscle is that the implants can be positioned in a more natural location (not as high on the chest as the submuscular position). Some women also feel that this placement is more comfortable. And finally, the recovery is slightly easier and more comfortable when implants are placed over the muscle.

Learn More about Breast Implant Placement

Keep in mind that the information in this post is for educational purposes only. The best way to make informed decisions about your breast augmentation surgery is to personally consult with Dr. Sanders and talk about your lifestyle, anatomy, needs and goals. To schedule a consultation, please call (818) 981-3333 today.