Breast Implant Placement- Over The Muscle, Under The Muscle or Dual Plane?

If you’re considering Breast Augmentation, one of the decisions to be made is where the surgeon will place the breast implant. There are two general  options: over or under the chest muscle (or pectoralis). In addition to this, we have the dual plane options, which are basically variants of the under muscle implant placement techniques.  In this blog, you will learn how Specialist Plastic Surgeon Eddy Dona can use any of these options to help you achieve your best look, as well as the pros and cons of each placement option.

Under the skin, the breast region comprises the breast gland overlying the chest muscles (Pectoralis major and minor). When surgeons place the implant over the muscles but under the breast gland, the position is subglandular (otherwise known as Prepectoral or Over  The Muscle). If they put it under the muscles, the position is submuscular (otherwise known as Under The Muscle or subpectoral). Finally, you have variations of under the muscle placements that are referred to as  Dual Plane Placement.

Each placement technique has characteristics that could make one more suitable for you than the others. The submuscular placement is more natural-looking because it offers additional muscle coverage, but it takes longer to heal than the subglandular placement. However, the subglandular placement can result in visible implant edges, giving a less natural look, especially in women with minimal natural breast tissue.

Over the Muscle (Subglandular) Implant Placement: Pros and Cons

‘Over The Muscle’ or Subglandular implant placement is when the implant is placed between the breast gland above and the chest muscles beneath. This placement option is ideal for women with dense natural breast tissue and elastic skin that can support the implant. Women who seek an enhanced cleavage can benefit from the subglandular placement because of the often times greater implant edge demarcation achievable with this approach.

Pros

• Subglandular implant placement offers a shorter less painful recovery time because surgeons don’t have to cut through deeper structures like the chest muscles and less chest tension exists.
• It offers a more dramatic (obvious) enhancement in breast size and shape.
• There’s no risk of animation deformity (breast deforming when the chest muscles contract) since implants are above the chest muscles.

Cons

• Visible implant edges and ripples are more likely in subglandular implant placement, especially in thin women with small breasts.
• There’s also a slightly higher risk of capsular contracture (when the scar tissue around the breast implant becomes abnormally hard and tight).
• They are less stable and can potentially move more over time.

Under the Muscle (Submuscular) Implant Placement: Pros and Cons

Surgeons insert the implant behind the chest muscle (specifically Pectoralis Major) for the submuscular (under the muscle) implant placement. The deep placement here makes this option more suitable for thin women with minimal breast tissue.

Pros

• It mimics the natural breast look better than other placements.
• There’s less risk of capsular contracture.
• There’s less potential interference with mammography results.
• The extra layer of muscle coverage reduces risk of visible implant edges and rippling.

Cons

• The procedure is more invasive, has more associated discomfort and may take longer to recover. Surgeons have to cut through the chest muscles to place the implant.
• There’s a risk of animation deformity.

Dual Plane Implant Placement: What Is It and How Does It Work?

Technically speaking, all implants placed under the muscle should be referred to as dual plane. No implants are fully covered by muscle. Dual plane means that part of the implant is covered by muscle, whilst the other part (typically the lower outer aspect of the implant) is only covered by the breast tissue and not the muscle.

Not to confuse matters, but different types of dual plane techniques exist, depending on how much implant is covered by muscle.

By varying the degree of dual plane, the surgeon can affect the final shape and outcome of your results depending on what the ley objectives were prior to surgery.

The following video animations by Dr Dona will help explain the above.

Breast Implant Pockets – A Simple Explanation

Dual Plane Type 1

Dual Plane Type 2

Aesthetic Outcomes: How Implant Placement Affects Breast Shape and Movement

Subglandular (over the muscle) implant placement can offer a more dramatic change in breast shape. However, the dual plane placements can give a more natural contour. Conversely, subglandular implants allow for more natural breast movement, especially in women with adequate breast tissue to cover it. At the same time, submuscular placement can make the breasts move when the chest contracts (dynamic animation).

The following video by Dr Dona will help explain this issue:

Beyond implant placement, other factors including breast implant shape and size, body anatomy, and extent of physical activity can affect breast shape and movement after surgery. It’s essential that you discuss your expectations with Dr Dona, who will consider what placement is best for your desired outcome. Dr Dona will also inform you of the potential limitations of your choice and what to expect for movement and appearance after Breast Augmentation.

Recovery and Healing Differences Between Placement Options

Generally, the subglandular placement has a faster recovery and healing time than submuscular / dual plane because the surgeons don’t have to cut and manipulate the chest muscles and other deeper structures. However, individual differences exist, and recovery time still varies from person to person.

Choosing the Right Placement for Your Body Type

The right placement for you depends on your body type and lifestyle, and Dr Dona always considers this before making a decision. Thin women with smaller breast tissue get better results from submuscular placement, while women with adequate breast tissue can easily opt for sub-glandular placement. If you have mild to moderate saggy breasts, dual implant placement is typically a better option.

Impact of Implant Placement on Physical Activity and Exercise

Subglandular implant placement offers considerable comfort during mild to moderate exercise but there’s a risk the implant pocket stretching more over time due to ongoing vigorous or high impact sporting activities. On the other hand, submuscular placement is more stable during exercise, but heavy lifting and chest exercises may cause discomfort due to increased pressure on the chest area.

Generally, exercise after Breast Augmentation surgery is a gradual process and you should listen to your body and your surgeon before engaging in intense physical activity.

Which Placement Option Provides a More Natural Look?

Submuscular / dual plane placement options generally give a more natural look over a subglandular placement. Moreover, they offer less risk of visible implants and rippling but can take longer to heal.

Implant Placement and Long-Term Outcomes: Durability, Shifting, and Sagging

Submuscular implant placement is considered more stable because it is behind the muscle, well supported and less prone to capsular contracture. Hence, they often last longer and stay in place. Subglandular implants may shift with vigorous activity because they have less tissue support and a higher risk of capsular contracture, reducing their durability.

Surgeon Recommendations: Deciding the Best Placement for Your Goals

Every client has an image of how they want to look after Breast Augmentation surgery. During your consultation, Dr Dona will consider your goals, your lifestyle, and all your key anatomical issues including breast size, shape, symmetry and chest wall anatomy.  A precise surgical plane will then be created to give you the best chance of achieving your desired results.