Implant placement relative to the pectoralis major muscle continues to be a source of controversy. Although the majority of plastic surgeons prefer submuscular placement there is still a large group of plastic surgeons who feel strongly about subglandular placement. Each group can make convincing arguments regarding their position of choice. It’s safe to say both approaches have advantages and disadvantages.
In the context of these discussions we feel that every patient needs to be considered individually. Each patient has unique anatomic findings that effect the decision to place the implant under or over the muscle. The aesthetic goals of the patient are equally important and have a significant impact on the decision as well. The vast majority of patients are striving for larger breasts with a natural look. They want balance, harmony, and proportion with the surrounding structures.
The majority of breast implants are placed in a submuscular position. There are several advantages to this approach. These include more soft tissue coverage which results in fewer visible folds, creases, and ripples in the implant. This is especially important in women who have thin skin and minimal breast tissue who want saline implants. Another advantage of submuscular placement is a lower incidence of capsular contracture. This phenomena results in hardening and distortion of the breasts. Patients can also have significant pain with capsule formation. Capsular contracture can occur with the implant in either position but the incidence is higher when the implant is placed on top of the muscle. For these reasons, submusclar placement gives a more natural look in most cases.
Placement on top of the muscle should be considered in female body builders who have large muscles which can distort the implant during contraction. In women with breast sag, implants can be placed on top of the muscle to avoid a breast lift and scarring.
Every patient should be considered individually. It’s important that you meet with a board certified plastic surgeon who can help obtain your aesthetic goals.