Every plastic surgery website seems to have a different opinion regarding implant placement during breast augmentation. Should implants go over the muscle, under the muscle or half-and-half?
To get the most natural feel and desired shape, the placement will be determined by a surgeon based on your physiology. A technique will be chosen after discussing the desired look with a patient and examining the amount of breast tissue available. At Maryland Plastic Surgery, we use a highly personalized approach by choosing from three incision types and four different implant placements based on individual consultations.
Here are some considerations that affect placement:
The original breast augmentation technique, this placement is referred to as sub-glandular, according to ImplantInfo. The implant is inserted below the breast tissue but above the muscle.
Women who have adequate breast tissue are great candidates for this option, and in the right conditions, women may experience the most natural looking results. The only thing covering the implant will be breast tissue (mammary glands and fat), and skin, which will conform to the shape of the implant. Assuming the tissue is dense enough, no rippling will be visible.
Unlike other options, women who regularly strengthen their chest muscles should not see alterations in shape or appearance during a workout.
Sub-muscular implants are fully covered by chest muscles. It's believed that this type of procedure can decrease the amount of rippling and reduce long-term sagging of the implant since muscle does not relax the same way skin does as a person ages.
Women who have a limited amount of breast tissue will also benefit. With a small amount of mass covering the implant, patients may notice an unusually rounded appearance or visible rippling if they go with a sub-glandular option. By putting the implant under the muscle, there is more tissue to mask it, creating a less artificial look.
The major benefit to this type of procedure is a potential decrease in risk for capsular contracture. Up to 10.7 percent of breast augmentation patients may experience this complication which causes excessive scar tissue to build up around the implant resulting in firmness or unnatural appearance. To resolve the problem, a second surgery may be required. In a study published in the Archives of Plastic Surgery, it's shown that sub-muscular implants can help reduce the risk of capsular contracture.
For patients who are not good candidates for sub-muscular placement, there has been some data that supports similarly decreased risk using over-the-muscle textured implants.
Partial sub-muscular placement goes by many names including dual plan and sub-pectoral. It involves putting the implant under the pectoralis major muscle. Because of the anatomy of this muscle, the implant will only be half covered. Most of the benefits of using a full sub-muscular technique also apply to this method.
While it's good to do research before undergoing any cosmetic procedure, only you and your doctor will be able to determine the best surgical plan for your body.