Breast Implant Placement: Above and Below the Muscle Explained

When considering breast augmentation, one of the most critical decisions involves the placement of the implants. This decision can significantly impact the aesthetic outcome, recovery process, and long-term satisfaction. 

The primary options for implant placement are completely above the muscle (subglandular), above the muscle but under the fascia (subfascial), below the muscle (submuscular), and a combination of both (dual plane). 

Let’s delve into these options, what each entails, the anatomy involved, and other key considerations. ⤵️

Above or Below the Muscle – What Does It Mean?

The terms “above the muscle” and “below the muscle” refer to the positioning of the breast implant relative to the pectoralis major muscle, a thick, fan-shaped muscle situated at the chest.

Anatomy – The Pectoralis Muscle

Understanding the anatomy of the pectoralis muscle is crucial for grasping the different implant placement options:

• Subglandular Placement: This method places the implant completely above the pectoralis muscle but beneath the breast tissue. It is often chosen for its simpler surgical procedure and quicker recovery time.

• Subfascial Placement: Here, the implant is positioned above the muscle but UNDER the fascia (a thin layer of connective tissue) of the pectoralis muscle.. This technique aims to combine the benefits of subglandular and submuscular placements.

• Submuscular Placement: the entire breast implant is under the intact pectoralis muscle.  Due to the nature of the thickness and shape of the pectoralis muscle, it is difficult to impossible to achieve this unless the implant is displace laterally, towards the underarm.  This is why a “dual plane” approach was created.

• Dual Plane Placement: This approach involves placing the implant partially under the pectoralis muscle and partially under the breast tissue. It provides a more natural contour and reduces the risk of complications like capsular contracture. It also allows the implant to be positioned properly on the rib cage and chest wall, to achieve the most aesthetic look possible. 

Other Key Considerations

When choosing the placement of breast implants, several factors should be taken into account:

• Overall Activity Levels: For highly active individuals, subfascial or dual plane placements might be preferable as they offer more support and reduce the risk of implant displacement during physical activities.

• Cleavage (Intermammary Distance): The distance between the breasts can be influenced by the placement. Subfaaical placement might provide more cleavage, while submuscular placement can offer a more natural look.

• Overall Feel/Softness: Implants placed above the muscle generally feel softer and more natural to the touch. However, submuscular placement can offer a more natural appearance, especially in women with less natural breast tissue.

• Rippling and Wrinkling: These are more common with subglandular placement, particularly in women with thin breast tissue. Submuscular or subfascial placement can help minimize the visibility of rippling.

Most Common Placement – Dual Plane

The dual plane placement has become the most common choice among surgeons due to its balanced benefits. By positioning the implant under both the muscle and breast tissue, it combines the natural look and feel of submuscular placement with the enhanced cleavage of subglandular placement. This method also reduces the risk of complications and provides a more aesthetically pleasing result for a wide range of body types.

The Future – Subfascial Placement

Looking ahead, subfascial placement is gaining popularity as it offers a promising alternative. This technique aims to provide the benefits of both subglandular and submuscular placements by positioning the implant under the muscle fascia but above the muscle. It potentially offers a more natural feel and appearance while minimizing complications associated with other methods.

Conclusion

In conclusion, the choice of breast implant placement is a highly personalized decision that should be made in consultation with a qualified plastic surgeon. Understanding the options and their implications can help you make an informed decision that aligns with your aesthetic goals and lifestyle.

For a visual and more detailed explanation, watch my YouTube video on this topic  ⤵️