What Is the Difference Between an Implant Placed Above the Muscle Versus an Implant Placed Under the Muscle?

If you are hoping to increase or restore the size and shape of your breasts, a breast augmentation procedure can support your aesthetic goals and help you achieve your ideal body type.

A breast augmentation procedure involves inserting breast implants to change the size or shape of the breasts. In some cases, breast augmentation surgery is combined with a breast lift to tighten or reshape the breasts.

There are many options to consider when deciding to proceed with breast augmentation surgery, but the optimal breast implant for you depends on your unique body, lifestyle, and goals for plastic surgery. A highly experienced, board-certified plastic surgeon can work with you to select the breast implant that will help you achieve your desired aesthetic.

How do breast implant placement options compare?

There are two types of breast implants: saline implants and silicone implants. Each implant type has potential pros and cons for each patient.

Silicone implants are filled with a silicone gel and are the most common option for breast implants because they generally yield a more natural-looking breast. However, the incision to insert a saline implant is larger than for silicone implants, and it can be difficult to detect a rupture in a silicone implant without an MRI.

Saline implants require smaller incision sites, and they are adjustable for individuals hoping to balance uneven breasts. However, they may exhibit small wrinkles over time, and some individuals may find they feel and/or look less natural than silicone implants.

Breast implant shape and incision site

When choosing a breast implant, the implant shape and incision site may also influence your aesthetic results.

Shape

Round implants are the most common implant shape. These implants are typically more cost-effective and result in greater breast projection after placement.

Teardrop-shaped implants mimic the natural shape of the breast more closely, so some individuals prefer their appearance. However, teardrop-shaped implants are more likely to shift position over time, which could eventually require a breast implant revision. These implants are generally preferred in breast cancer reconstruction cases.

Incision site

Incisions to place breast implants may either be hidden in the breast fold (this is called an inframammary fold crease incision) or within the nipple (a periareolar incision).

For individuals with sufficient natural breast tissue to create a breast crease, an inframammary fold crease incision is often the preferred option. This conceals the incision site beneath the breast while giving the plastic surgeon maximum control over the position of the implant.

Individuals without a clearly defined breast fold or those with a strong areolar border may prefer to have implants placed with a periareolar incision. In some cases, this incision may temporarily affect nipple sensation (which typically returns within a few months for most individuals). If you plan to breast feed in the future, discuss this with your plastic surgeon.

Breast implant placed above the muscle versus an implant placed under the muscle

When a plastic surgeon inserts a breast implant, there are two options for how the implant is placed around the chest muscles:

1.   Over the muscle (subglandular placement)

An over-the-muscle breast implant, also known as a subglandular implant placement,  involves inserting the breast implant over top of the pectoral muscles but under the natural breast tissue. This technique places the implant below the glandular breast tissue responsible for lactation to avoid interfering with potential breastfeeding goals.

Because this approach minimizes disruption to the body’s muscles, it is often easier for plastic surgeons to undertake and results in a more comfortable recovery for patients.

Individuals with a significant amount of pre-existing breast tissue—typically a B-cup or larger—often achieve best results from a subglandular breast implant procedure, as they have enough breast tissue to cover the implant entirely after placement and yield optimal aesthetic results. Individuals with smaller breasts prior to surgery, on the other hand, may notice rippling in the implant over time.

It’s important to note that the subglandular placement technique can make it more difficult for physicians to read mammograms accurately. Additionally, this placement method does increase the risk of capsular contracture, or scar tissue formation, around the implant.

2.   Under the muscle (subpectoral or submuscular placement)

Under-the-muscle placement of a breast implant involves positioning the implant under the pectoralis major muscle.

Subpectoral implant placement typically results in less scar tissue, which decreases the risk of capsular contracture over time. It can also yield a more natural-appearing breast, especially for individuals with smaller breasts, and the deeper placement makes the implants less likely to shift with time or high activity levels. Additionally, submuscular implant placement is less likely to interfere with breast screening exams like mammograms.

However, it’s important to note that some patients may experience greater discomfort post-surgery since the pectoralis muscles are disrupted during surgery

Which implant placement option is right for me?

Most individuals obtaining breast implants receive an under-the-muscle, or submuscular, placement. However, the implant placement that is best for you may depend on your current breast size, goals for surgery, and activity level.

The best way to determine where to place breast implants is to consult with a board-certified plastic surgeon. They will examine your natural build, aesthetic goals, and current lifestyle to determine whether a subglandular or submuscular placement is the right option for you.

Consult with a board-certified plastic surgeon

You do not need to decide where to place breast implants on your own. A qualified plastic surgeon will work with you, showing before and after photos of breast augmentation, breast lift, and breast implant revision procedures they have successfully performed and providing you with patient reviews as you make your decision.

At Maman Plastic Surgery, our team walks you through the plastic surgery process from start to finish to ensure that you achieve your desired surgical results. To begin moving towards your most confident body image, request a consultation.