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.