Implants Above or Below the Muscle

One of the first choices you need to discuss with your surgeon is whether you should have your breast implants placed above or below the Pectoralis Major muscles. The Pectoralis Major muscle is a large, triangular muscle that reaches across the chest with one end at the shoulder and one side attached to the chest bone.

Placing the implant "above or below the muscle" is a term misunderstood by many people; in both cases, the implant is behind the mammary glands and the breast tissue. Both approaches have some advantages and disadvantages. Your individual body type, the amount of breast tissue you have and your goals for size and shape will help you and your surgeon determine which position is best for you.

Originally, silicone gel implants were placed above the muscle. Although this worked well in many cases, a significant number of patients, developed capsular contracture, which is a hardening of the scar tissue around the implant.

During the 1970's, breast reconstruction became popular for cancer patients. With no breast tissue to work with, surgeons began placing implants underneath the pectoral muscle. Over time, this procedure proved to lessen the occurrence of capsular contracture. As a result, many surgeons began placing the implant beneath the muscle in most or all of their patients.

The submuscular position (behind the muscle) may have problems of its own. When the pectoral muscle contracts, such as during exercise, the breast changes shape. Another drawback is that the implant, for several months, maintains a high position on the chest wall. It will, however, drop and assume the correct position

Each breast has it's own unique needs. Below is a quick reference guide to give you an idea of what to expect:

If you have very little breast tissue, you will most likely want to "go behind the muscle". With little tissue to cover the implant, the roundness of the implant may be obvious as well as increased visibility of any rippling that occurs. Also, the presence of the implant will be obvious when you touch it. The extra layer of muscle covering the implant will disguise much of the palpable rippling.

If you have some breast tissue (approximately 3 cm or more) you have more choice between above and below the muscle placement. If placed under the muscle, the implant is more likely to move when you perform exercises that use the chest muscles.

If you have very little breast tissue and a droopy breast, a silicone implant would be a good solution. The implant can give a very soft, natural feel and look. Keep in mind the potential for wrinkling and rippling is always a possibility in breast implant surgery.

If you have some breast tissue and a sagging breast , you will probably want to go above the muscle. Even though the breast itself is drooping, the chest muscles are still in their proper position. If you put an implant behind the chest muscle, your breast would still droop but now you would have a breast implant pushing out from the chest wall above the rest of the breast.

If you have a droopy breast with sufficient breast tissue, the implant can be placed in front of the muscle and the tissue should cover the implant nicely. However, you can't fight gravity forever. The additional weight of the implant can create more ptosis (drooping) over time. Wearing a sturdy bra can fight gravity.

Finally, if there is significant ptosis, a breast lift may need to be done along with the breast implant.

As you can see, the placement of your implants may not be a cut and dry decision. If you would like more information or would like to come in and see what options would work best for you, call us at (866) 731-3198.