Over the Muscle Implants: Pros, Cons, and What You Need to Know

Introduction

Breast augmentation is one of the most popular cosmetic procedures worldwide, with millions of women opting for implants to enhance their appearance and boost self-confidence. When it comes to implant placement, one of the key decisions is whether to go over or under the muscle. In this article, we'll focus on over the muscle implants, also known as subglandular or prepectoral placement, exploring their advantages, potential drawbacks, and what you need to know before making your decision.

What Are Over the Muscle Implants?

Over the muscle implants, as the name suggests, are placed above the pectoralis major muscle and directly behind the breast tissue. This technique differs from the submuscular placement, where implants are positioned partially or fully under the chest muscle.

Advantages of Over the Muscle Implants

There are several benefits to choosing over the muscle placement:

• More Natural Look and Feel: Since the implant is placed directly behind the breast tissue, it can create a more natural-looking result, especially for women with adequate existing breast tissue.
• Faster Recovery: With no muscle manipulation required, patients typically experience less post-operative pain and a quicker recovery period. Tonguc Isken et al. (2009) noted that this approach can lead to reduced postoperative discomfort.
• No Animation Deformity: Unlike submuscular implants, over the muscle placement eliminates the risk of breast distortion during chest muscle contraction, a phenomenon known as animation deformity.
• Easier Revision Surgeries: If future adjustments or replacements are needed, accessing over the muscle implants is generally simpler.

Potential Drawbacks and Considerations

While over the muscle implants offer many benefits, there are also some potential drawbacks to consider:

• Higher Risk of Capsular Contracture: Some studies suggest that over the muscle implants may have a higher risk of capsular contracture, a complication where scar tissue around the implant hardens and squeezes the implant. T M Biggs et al. (1988) observed that placing implants behind the pectoral muscle could lead to a decrease in capsular contracture rates.
• More Visible Implant Edges: Particularly in women with thin breast tissue, the edges of over the muscle implants may be more visible or palpable.
• Potential Interference with Mammograms: Subglandular implants can sometimes make it more challenging to visualize breast tissue during mammograms, although modern imaging techniques have largely mitigated this issue.
• Possible Sagging Over Time: Without the additional support of the chest muscle, there may be a slightly higher risk of implant descent or bottoming out over time.

Who Is an Ideal Candidate for Over the Muscle Implants?

Over the muscle implants may be particularly suitable for:

• Women with adequate existing breast tissue to cover the implant
• Those seeking a more dramatic upper pole fullness
• Athletes or bodybuilders who want to avoid muscle interference
• Patients undergoing a breast lift in conjunction with augmentation

The Surgical Procedure

The procedure for placing over the muscle implants is typically straightforward:

1. An incision is made, usually in the inframammary fold, around the areola, or in the armpit.
2. A pocket is created behind the breast tissue but in front of the pectoral muscle.
3. The implant is inserted into this pocket and positioned for optimal results.
4. The incision is closed, and the healing process begins.

Carlos Barbato et al. reported on a technique where implants are placed behind the breast fascia but in front of the pectoralis major muscle, aiming to achieve proper coverage and good support of the implant.

Recovery and Aftercare

Recovery from over the muscle implant surgery is generally quicker compared to submuscular placement. Most patients can return to light activities within a few days and resume normal activities within 2-3 weeks. However, it's crucial to follow your surgeon's post-operative instructions carefully to ensure optimal healing and results.

Conclusion

Choosing between over the muscle and under the muscle implants is a decision that should be made in consultation with a board-certified plastic surgeon. While over the muscle implants offer advantages like a more natural look and faster recovery, they may not be the best choice for everyone. Factors such as your body type, existing breast tissue, lifestyle, and aesthetic goals all play a role in determining the most suitable implant placement for you. By understanding the pros and cons of over the muscle implants and discussing your options thoroughly with your surgeon, you can make an informed decision that best aligns with your desired outcome.