Which Is Better, Above or Under the Muscle Breast Implant Placement?

Breast Augmentation, Breast Implants, Plastic Surgery, Plastic Surgery Blogs Comments (0)

Breast implant placement has a huge impact on the final result of breast augmentation surgery.  For this reason, cosmetic plastic surgeons will make every effort to explain to their patients the pros and cons of placing the device under or over the pec muscle.

Breast implants are placed in a pocket during the procedure; over time, the devices are secured by the scar tissue which can prevent them from shifting that can lead to asymmetrical appearance.  Meanwhile, the “pocket” is either placed above or below the chest muscle.

During the earlier years of breast augmentation, implants were only placed above the muscle; this allows the devices to move with the rest of the tissue.  And because no muscle has been shifted, patients can expect less pain and discomfort during recovery and quicker healing compared with under-the-muscle implant placement.  (See the example below.)

However, placing the breast implants over the pec muscle has several downsides, one of these is the higher risk of capsular contracture or excessive scar tissue around the implant shell.  Some experts suggest this is probably caused by “too much contact” between the device and the tissue which is believed to be harbored by staph bacteria.

While most of the time the early stages of capsular contracture can be treated with non-surgical methods (e.g., ultrasound treatment and certain medications such as Accolade and Singulair), breasts with visible distortion can only be addressed by a revision breast augmentation surgery.

Because of the higher risk of capsular contracture, many plastic surgeons today prefer placing the implants under the pec muscle which is also said to allow better mammogram reading.  But because the muscle is pushed by the devices, the tradeoff is longer recovery and more pain and discomfort while the body heals itself.

However, the under-the-muscle implant placement may result to “too much space” in the cleavage particularly for patients whose breasts are positioned wide apart.  Another consideration to make is that the device moves as the pec muscle is flexed.  (See the example below.)

Having explained the difference between overs and unders, it is safe to say that neither is superior nor inferior to the other as the “right” technique largely depends on the chest width and shape, patient’s goals and expectations, breasts anatomy, and surgeon’s skills.

But regardless of what implant positioning is used, breast augmentation cannot correct drooping; in fact, the surgery can even aggravate the condition particularly with the use of larger implants.  Fortunately nowadays, the procedure can be combined with mastopexy (breast lift).

Cosmetic Surgery Blogger @ January 17, 2012