If you’re considering breast augmentation or revision, one important decision you and your surgeon will need to make together is whether to place your new breast implants over or under your chest muscle. This placement matters for a number of reasons, and to help guide you in making this decision, board-certified plastic surgeon Dr. Movassaghi explains the differences between over and under the muscle breast implant placement in this post. Show
How do breast implant placement options compare?Breast implant placement is critical to providing a patient with the best aesthetic results, as well as to prevent issues, such as capsular contracture and implant rippling, from occurring. During breast augmentation surgery, breast implants are either placed underneath a patient’s breast tissue but over their chest muscles, or underneath their breast tissue and partially under their pectoralis major chest muscle. Placement in both locations can produce satisfactory results; however, there are pros and cons to each option, therefore your surgeon will assess your unique body type to determine which implant position is right for you. Over the muscle placementSubglandular, or “over the muscle,” implant placement is when a breast implant is placed on top of a patient’s muscles but beneath their skin, fat, and glandular tissue. Pros of subglandular placement:
Cons of subglandular placement:
Under the muscle placementThe term submuscular, or “under the muscle”, implant placement is somewhat misleading: while the breast implant is placed underneath a patient’s skin, fat, glands, and pectoralis major muscle (the outermost chest muscle), most surgeons actually place the implant on top of the inner pectoralis minor and serratus muscles so that the pectoralis major muscle covers the top and side of the implant. This leaves the bottom and outer edge of the implant covered only by the patient’s natural breast tissue. Pros of submuscular placement:
Cons of submuscular placement:
Breast revision: the other reason to consider implant placementIf you’ve already had a breast augmentation, you may be researching implant placement options because you’re interested in revising your breast implants. Breast revision surgery is often performed to exchange breast implants, but it can also be performed to correct common issues that occur over time, such as loose breast skin, as well as other issues that can develop, like implant migration, implant rippling, and/or capsular contracture (when the scar capsule around the implant constricts). During breast revision surgery, you and your surgeon may decide to change the placement of your implants to accommodate a new implant size or to correct any of these issues. How do I decide where to place my breast implants?Now that you are familiar with the two main breast implant placement options, how do you choose which one is best for you? Here are a few factors that will help inform your decision:
When choosing the size of the implant, it is more important to think about the shape of the breast you want instead of the amount of CC’s in the implant. My approach is to shape your breast rather than to volumize it. There are some general guidelines that are important when considering implant placement because the larger your implants are, the more likely any rippling is to be visible through your breast tissue. This is why women with larger breasts and more abundant breast tissue are better candidates for larger implants, while women with smaller breasts may have a more difficult time concealing larger implants. Generally, if you have minimal breast tissue and want larger implants, under the muscle placement will provide the best results as your pectoralis major muscles will help hide any possible rippling in your implants. It’s important to understand that as the size of your implants increase, so does your rate of short-term and long-term complications, and correspondingly, your chances of seeking an implant revision.
In general, silicone implants are less prone to rippling and visibility. There are also more options for silicone implants, both in size and shape and in gel materials. That said, there have been recent improvements to saline implants which make them ripple less and feel more natural than older versions. The options for saline implants are, however, more limited.
There are many factors to consider when choosing your implant size, shape, and location. Your anatomy, the ultimate shape and size of the breast you desire, and your lifestyle all play an important role in your decision. Remember, there is no “one-size-fits-all.” Together, we will decide on the right implant and implant location to achieve your goals during your consultation. What is the most popular implant placement option?There is no “Holy Grail” for implant type, size, shape, or location. What is right for one individual may not be right for another. In fact, Dr. Movassaghi just recently published a book titled, “Shaping the Breast: A Comprehensive Approach in Augmentation, Revision, and Reconstruction,” to address this exact issue, among others. Ready to discuss your implant placement options in Eugene? Consult Dr. MovassaghiIf you’re still unsure which implant placement option is right for you, don’t worry. During your consultation, board-certified plastic surgeon Dr. Kiya Movassaghi will measure your breast tissue thickness and help you understand your breast implant placement options in detail. Dr. Movassaghi has over 19 years of experience lecturing and performing breast augmentation and breast implant revision surgeries and would love to help you achieve your ideal augmentation results. Contact our Eugene office online or call (541) 686-8700 to schedule your consultation today. What is the best placement for breast implants?Submuscular placement
This technique includes placement of the implant partially under the pectoralis major chest muscle. PROS: Patients experience more accurate mammograms. In addition, the submuscular placement tends to produce a more natural appearance, and a reduced rate of capsular contracture.
Do over the muscle implants sag more?The truth is, whether implants are placed over or under the muscle, it will have very little to do with sagging. Sagging is commonly caused by weight gain or loss, pregnancy and gravity over time. It's easiest to remember it this way – it's the breasts that sag, not the implants.
Do over the muscle implants look bigger than under the muscle?Answer: Difference. Over time, the size will be about the same for under and over the muscle, however, under the muscle avoids the edge look and has less rippling and sagging. If you have minimal tissue or need a lift, placing the implants behind the muscle will give a better long term look.
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