Implant Over or Under Muscle: Pros, Cons, and What You Need to Know

Introduction

When considering breast augmentation, one of the key decisions you'll face is whether to place the implants over or under the muscle. This choice can significantly impact your results, recovery, and long-term satisfaction. In this article, we'll explore the pros and cons of each technique to help you make an informed decision.

Over-the-Muscle (Subglandular) Implant Placement

Subglandular placement involves positioning the implant directly behind the breast tissue and in front of the pectoralis major muscle.

Pros of Over-the-Muscle Placement

• Shorter recovery time: Research shows that patients with over-the-muscle implants required an average of 3.8 weeks to resume normal weight-room activities, compared to 7.2 weeks for under-the-muscle implants.
• Less post-operative pain: Since the muscle isn't disturbed, patients typically experience less discomfort after surgery.
• No implant displacement during muscle contraction: Unlike submuscular implants, subglandular implants don't move when chest muscles are flexed.

Cons of Over-the-Muscle Placement

• Higher risk of visible rippling: Especially in thin patients with little natural breast tissue.
• Potentially less natural look: May appear more augmented, particularly in the upper pole of the breast.
• Slightly higher risk of capsular contracture: Some studies suggest a higher incidence of this complication with subglandular placement.

Under-the-Muscle (Submuscular) Implant Placement

Submuscular placement involves positioning the implant partially or fully beneath the pectoralis major muscle.

Pros of Under-the-Muscle Placement

• More natural appearance: The muscle provides additional coverage, creating a more gradual slope in the upper pole of the breast.
• Lower risk of visible rippling: Especially beneficial for thin patients with minimal breast tissue.
• Potentially lower risk of capsular contracture: Some studies suggest that total musculofascial coverage may provide protection against certain implant-related complications.

Cons of Under-the-Muscle Placement

• Longer recovery time: Patients may need more time to heal due to muscle manipulation during surgery.
• Potential for animation deformity: The implant may move or become distorted when chest muscles are flexed.
• More post-operative pain: Due to the manipulation of the muscle during surgery.

Factors to Consider When Choosing Implant Placement

Several factors should influence your decision:

1. Body type: Thin patients with little natural breast tissue may benefit more from submuscular placement.
2. Lifestyle: Athletes and bodybuilders might prefer over-the-muscle placement to avoid animation deformity.
3. Desired outcome: The look you're aiming for can influence the best placement option.
4. Mammography considerations: Under-the-muscle placement may interfere less with future breast imaging.

New Techniques and Hybrid Approaches

Recent advancements have led to new techniques that aim to combine the benefits of both approaches:

• Dual-plane technique: This method places the implant partially under the muscle, aiming to provide the benefits of both over and under placement.
• Subfascial placement: Some surgeons advocate for placing implants above the muscle but below the fascia, potentially offering a compromise between the two traditional methods.

Conclusion

The decision between over-the-muscle and under-the-muscle implant placement is highly individual. While under-the-muscle placement may offer more natural-looking results and lower complication rates for some patients, over-the-muscle placement can provide quicker recovery and less post-operative discomfort. Consult with a board-certified plastic surgeon to discuss your goals, body type, and lifestyle to determine the best option for you.