Location of the implant; “Under the muscle or on top of the muscle” is concept is a little complex to understand and we are giving a simplified description here. Basically the implants can be placed in one of two positions on the chest wall. Implants can be placed underneath the breast alone. This is called “subglandular or submammary placement.” In the subglandular position, the implant sits on top of the pectoralis muscle and directly underneath the breast tissue. The other position for implant placement is in the “submuscular position.” In this situation the implant is placed underneath the pectoralis major muscle and breast tissue. In the submuscular position the implant sits directly on the chest wall underneath the muscle and breast tissue.
There are advantages and disadvantages to each position for the implant. If possible we prefer to place the implant under the breast and muscle. (submuscular placement.) This placement allows for more of your body tissue to cover the implant. With greater natural tissue coverage of the implant, the implant feels more natural and there is less chance or implant rippling or scar formation. It is important to know that even in the submuscular position, the pectoralis muscle may not cover the inferior portion of the implant.
Sometimes placing the implant directly under the breast or subglandular position is better for patients. This position or placement of the implant is sometimes better for patients who have droopy or sagging breasts. It is also sometimes better for patients who have extremely narrow or tube shaped breasts called tuberous deformity. There are other reasons for placement in one or the other position and there are variations to the two standard positions. There is even a position that is half under the muscle and half over the muscle called the “dual plane” position. This position is a compromise of the benefits of the subglandular position (more lift,) and the submuscular position (more tissue coverage.) In general, Dr. Smith will help guide you with this decision.
Subglandular vs Submuscular
You may have not known this, however breast implants placement can be under or on top of the muscle. Specifically, under or on top of the pectoralis major muscle. Plastic surgeons debate the benefits of both the positions, however you’ll have the ultimate decision when it comes to your surgery. Generally, most Las Vegas plastic surgeons will agree under muscle is the better implant placement. When you’re in your consultation, you’ll be asked about your concerns. Concerns like what your aesthetic goals are, your lifestyle, recovery time, etc… All of these questions will help you determine which is best for you.
When the implant is placed under the muscle this is called the submuscular position. When the implants are under the muscle, more of the patient’s natural tissue covers the implants. This helps make the implants look and feel more natural. Also the muscles help to hold them in alittle bit so they don’t roll out into the armpit as much and the muscles hide the rippling that can sometimes occur when the implantsare on top of the muscle. In addition to this when more of the patient covers the implant the implant tends to look and feel more natural. Dr. Smith almost always places the implants under muscle. Some of the disadvantages of placing the implant under the muscle is when you flex — for example when you’re doing push ups or pull ups, the pectorlais muscle will bounce a little bit. Or you’ll be able to see the crease of your muscle, this is also a disadvantage of placing the implant under the muscle.
When the implant is placed on top of the muscle and under only the breast tissue, this is called the subglandular position. The advantages of placing the implant on top of the muscle is that it is a quicker recovery. I’ll suggest this option to you if you have abnormally shaped breasts, so we can help round out your breasts. The disadvanatage of placing the implant on top of the muscle are many. The implants tend to have a more “stuck on” look, giving you a more pronounced size. There is a higher chance of the implants rippling and skin tends to stretch, which after a while leads to implants rolling into the armpit when you lay down. Still, you may desire to have a more exaggerated look and may consider putting the implants on top of the muscle. The advanatages of placing the implant under muscle outweight the disadvantages, so Dr. Smith usually places the implant under muscle.
Implants tend to drop, so when the implant is placed during surgery, Dr. Smith will place it slightly high. If the implant is placed under the muscle the muscle tends to push them alittle higher immediately after surgery. This means that about a week after surgery, you will think the implants are too high. Your skin and muscles need to stretch, so the implants tend to drop for 3-6 motnhs. Within that time period, your implants will be set in their new position and will usually cease to drop. It is important that you implants are not perfect right away, or they will drop too low and may look droopy. This is actually the most common risk of breast augmentation, and runs about 5% in Dr. Smith’s practice. In the event you implants drop too low, or fail to drop enough, Dr. Smith will adjust them to help them be in the proper position.