Breast Implant Position – Over or Under the Pectoralis Muscle? Which is right for you?

“The placement of the breast implant is one of the key decisions to discuss with your plastic surgeon. While most patients in my practice have the implant placed under the muscle, there are cases where over the muscle may be beneficial,” says Dr. Paul Wigoda.

Take a moment to look at the diagram below to see the size and location of the muscles that make up your chest wall. You will notice that the pectoralis major muscle is a large fan-shaped muscle that does not cover the lower, outer aspect of your chest wall. Generally in breast augmentation surgery the pectoralis major muscle will be detached from its lower origin along the ribs and the implant will be placed under it leaving only about half the implant covered by the muscle. The bigger the implant, the less of it that is covered by the muscle.

 

The pectoralis minor muscle is much smaller and lies under the outer edge of the pectoralis major. The serratus muscle lies along the sides of your chest wall. The main sensory nerves to your breast come up between the slips of this muscle to enter the back of your breast tissue and from there to the rest of your breast. Generally surgeons place the implants on top of the pectoralis minor and serratus muscles, but below the pectoralis major muscles.

There are pro’s and con’s to having your implants placed over or below the muscle. Here are some things to consider:

Over the Muscle (Subglandular) Breast Implant Placement:

  • Pros: When textured implants are used, the capsular contracture rate is only 5–10%. If you have a moderate amount of breast tissue (a B cup or larger), this can be an excellent choice and produce very natural-looking breasts that age very well. Also, recovery is usually easier than when the implants are placed in a submuscular position.

  • Cons: The use of smooth implants in a subglandular position have an increased rate of capsular contracture compared to other options. Additionally, when textured implants are used in thinner women with small breasts rippling may be visible in the upper and inner areas. It is also easier to see the upper edges of the implants when they are placed over the muscle.

Under the Muscle (Subpectoral) Breast Implant Placement:

  • Pros: Using smooth implants under the pectoralis muscles reduces the capsular contracture rate to less than 10%. In thinner women, the added bulk of the muscle over the upper and inner aspects of the implants will make the edges less visible and the curve of the breast more natural. When textured implants are used, the rippling in the areas under the muscle is usually invisible.

  • Cons: The recovery is typically thought to be more uncomfortable. However, with Dr. Wigoda’s painless breast implant procedure, patients most often have implants placed below the muscle and have little or no pain. It can take several months to see your end results because the implant tends to start out high before it settles into its final position, lower on the chest. When the pectoralis muscle is contracted during exercise or in some daily movements, the muscle may flatten the implants and push them outward. This can change the shape of the breast. However, this does not happen in all patients. Occasionally, an indentation over the implant can be seen along the edge of the muscle but again, this is not typical. When there is a moderate amount of breast tissue that is lax or becomes lax in time, it may sag below the position of the implant that is held in place by the muscle.

Dr. Paul Wigoda’s Fort Lauderdale-based plastic surgery center offers both subglandular and subpectoral procedures and we are happy to help you decide what’s best for you during a free consultation.  Call us at 954.463.7088 to schedule your visit! www.drwigoda.com