Under Muscle Breast Implant Surgery vs Over: What’s Best for You?

Under-muscle breast implant surgery, also known as submuscular placement, involves positioning the breast implants beneath the pectoralis major muscle.

• Natural feel: Implants under the muscle are covered by both the muscle and breast tissue thereby reducing the risk of implant palpability.
• Reduced Rippling: The additional coverage provided by the chest muscle can help minimise the visibility of implant edges and rippling.
• Lower Risk of Capsular Contracture: Placing implants beneath the muscle has been associated with a lower risk of capsular contracture, a condition where scar tissue tightens around the implant.

• Longer Recovery: Recovery time can be longer compared to over-muscle placement due to the necessary surgery on the muscle.
• Implant animation: Some patients experience movement of the implant during contraction of the pectoralis major muscle.

Over-muscle breast implants (subglandular placement), are positioned above the pectoralis major chest muscle but beneath the glandular breast tissue. This method is suitable for patients with adequate natural tissue to cover the implants.

Shorter Recovery: Since the chest muscles are not dissected, recovery time is generally shorter.
Natural position: As breast tissue is positioned above the muscle, the natural position for an implant to enhance the breast would also be above the muscle and behind the breast tissue.

Visible Rippling: There is a higher chance of visible rippling and implant edges, especially in patients with little natural breast tissue.
Higher Risk of Capsular Contracture: This placement may have a slightly higher risk of capsular contracture compared to submuscular placement.

• Shorter Surgery Time: The procedure is generally quicker and less invasive.
• Faster Recovery: Patients often experience a faster recovery time since the chest muscles are not affected.
• Sufficient Coverage: For those with sufficient breast tissue, the implant edges are less likely to be visible.

• Risk of Rippling: Patients with little natural breast tissue may experience more visible rippling.
• Capsular Contracture: There is a slightly increased risk of capsular contracture compared to muscle implant placement.

With the evolution of techniques, slight variations in the classical pocket placements have been developed. The more popular of these variants include the dual plane and the subfascial pockets.

Dual plane placement is a hybrid technique that combines the benefits of both submuscular and subglandular placements. During breast augmentation surgery, the upper part of the implant is placed under the muscle, while the lower part sits beneath the glandular tissue.

• Soft issue coverage: The additional muscle cover in the upper half of the implant reduces the risk of implant palpability or visibility as well as rippling.
• Reduced Bottoming Out: The implant is less likely to shift downward over time.

• Implant animation: Some patients experience movement of the implant during contraction of the pectoralis major muscle.
• Extended Recovery: Recovery can be longer due to the release of the muscle.

Subfascial placement involves positioning the breast implants beneath the fascia, a thin layer of tissue covering the muscle, but above the actual muscle.

• Stability: This placement provides good implant stability and reduces the risk of movement.
• Natural position: The implant is still positioned above the muscle, like the breast tissue.
• Short recovery: The technique requires a recovery time similar to subglandular placement, as the muscle itself is not disrupted.

• Technical expertise: The fascia is a thin layer and requires meticulous technique and experience to perform.
• Soft tissue coverage: The fascial layer is thin and therefore no significant additional soft tissue coverage is provided to mask the implant other than the breast tissue.

A personalised consultation with a plastic surgeon on the specialist register Mr Hyder Ridha is crucial. He can assess your unique anatomy, discuss your goals and recommend the most suitable breast implant placement options for you. Whether you choose saline implants or silicone implants a tailored approach ensures the best outcome.