Should Your Breast Implants Be Under or Over the Muscle?

Understanding Breast Implant Placement

The breast implant placement you choose will affect the final look, feel, and recovery process of your augmentation procedure. There are two primary methods of placing breast implants: under the muscle (submuscular) and over the muscle (subglandular). Understanding these methods is essential for making an informed choice.

What Is Under-the Muscle Implant Placement?

In submuscular placement, a plastic surgeon positions the implant beneath the pectoral (chest) muscle. It involves an incision — typically on the fold that forms underneath the breast or in the armpit — and manipulating tissues to make space for the implant under the pectoral muscle.

What Is Over-the-Muscle Implant Placement?

In subglandular or submammary placement, a surgeon positions the implant above the pectoral muscle but beneath existing fat and breast tissue. It requires an incision, usually in the same locations as the submuscular method, and creating a pocket directly behind the breast tissue but in front of the pectoral muscle. The surgeon then inserts the implant into this pocket.

Each placement method has distinct advantages and drawbacks, which you need to think about carefully when planning for breast augmentation. The following sections dig deeper into the specifics under-the-muscle and over-the-muscle breast implant placements.

Pros and Cons of Under-the-Muscle Breast Implants

Let's take a look at the top benefits of submuscular placement:

• More natural appearance: Implants placed under the muscle often have a more natural look and feel, particularly in patients with less natural breast tissue. The muscle provides additional coverage, which can make the edges of the implant less noticeable. There's also less risk of visible wrinkling, rippling, or folding.


• Reduced risk of capsular contracture: This placement tends to lower the risk of capsular contracture, a condition where scar tissue forms tightly around the implant, causing it to harden. Specifically, according to the American Society of Plastic Surgeons, partial under-the-muscle implant placement has an 8 to 12 percent risk of capsular contracture, whereas over-the-muscle implant placement has a 12 to 18 percent risk. For implants placed completely under the muscle, the risk is much lower at 4 to 8 percent.


• Less interference with mammography: Since the implant is under the chest muscle, it is less likely to obstruct mammograms and other breast imaging tests, making it easier to screen for breast cancer.

As for the disadvantages of under-the-muscle implants, they include:

• Longer recovery time: While you may feel better after 2 to 4 weeks, healing can take an average of 6 weeks or longer, says Dr. Aldo Guerra, board-certified plastic surgeon and breast augmentation specialist in Scottsdale, Arizona. Recovery from submuscular placement can be longer since the muscle needs time to recover and adjust to the implant. Exercising or attempting strenuous movements too soon can delay this process further.


• Flattening: Modern breast implants in the U.S. are usually made with a cohesive silicone gel, which allows them to retain their shape over time. However, the implant may flatten temporarily when the pectoral muscle contract. Simply put, when the chest muscles contract, they will squeeze anything beneath them, including implants under the muscle. Athletes and bodybuilders, in particular, must consider this disadvantage when deciding between submuscular and subglandular placement. Nonetheless, the implants will return to their perky shape and appearance once the muscles relax.


• Possible animation deformities: Because the implant is under the muscle, contractions, such as those that happen during exercise, may cause an implant to move or change shape temporarily, known as animation deformities.


• Risk of muscle function loss: Since this option entails cutting and detaching the pectoral muscle, it may compromise muscle function and strength.

Pros and Cons of Over-the-Muscle Breast Implants

Moving on to the benefits of subglandular placement, they include:

• Shorter recovery time: Recovery from subglandular placement is often shorter and less uncomfortable due to the absence of muscle manipulation.


• Simpler surgical procedure: Placing the implant over the muscle typically involves a less complex surgical procedure.


• Less risk of animation deformities: Since the implant is not beneath the muscle, there is no risk of animation deformities due to muscle contractions.


• Appears more natural for some patients: If you have a lot of natural breast tissue, this option may give you the most natural-looking outcome. Positioning the implant over the muscle allows it to blend more seamlessly with the natural breast mound.


• Can accommodate larger implants: Subglandular placement may provide more flexibility in achieving your desired breast size. Since there are no restrictions from the muscles, it can be easier to go for bigger implants.

As for the disadvantages of over-the-muscle implants, they include:

• More noticeable rippling: Subglandular implants are more prone to visible rippling, especially in patients with thin skin or minimal breast tissue.


• Higher risk of capsular contracture: As mentioned, this placement option has a 12 to 18 percent lifetime risk of capsular contracture compared to its counterpart's 4 to 8 percent.


• More likely to affect mammogram results: Placing implants above the chest muscle can obscure portions of the breast tissue on mammogram images, potentially making breast cancer screening inaccurate.


• Requires sufficient breast tissue: Over-the-muscle implant placement may not be ideal for individuals lacking upper breast tissue. Without enough natural breast tissue to cover the implant, the edges of the prosthesis may become more visible or palpable, leading to a less attractive outcome.

FAQ: Does over or under the muscle look more natural?

It depends on how much breast fat or tissue you have. Generally, if you have less natural breast tissue, under-the-muscle placement provides more coverage for the implant, resulting in a more natural look and feel. If you have more natural breast tissue, over-the-muscle placement creates a smoother and natural-looking contour as the implant sits closer to the surface of the breast tissue. Existing breast tissue also provides additional coverage over the implant, which can help conceal the edges and create a softer, more natural appearance.

Where to Get Breast Augmentation Surgery in Scottsdale, Arizona

Now that you understand the pros and cons of submuscular and subglandular implants, you can book a consultation at Guerra Plastic Surgery Center for a breast augmentation Scottsdale area, knowing which technique aligns with your body, lifestyle, and aesthetic goals. During your appointment, you can discuss your findings with our doctors, who will also assess your unique anatomy to determine the best option. Are you ready to collaborate and take a step toward your dream silhouette? Get in touch with us today or call us (480) 568-2523.