One of the first decisions you must make before you go forward with breast enhancement is whether to have breast implants, (either silicone or saline) placed “under the muscle” (submuscular) or “over the muscle” (subglandular). The pectoral muscles or “pecs” consist of two muscles, the pectorals major and pectoralis minor. If your board certified plastic surgeon places the implants “over the muscle,” it means the implant sits sandwiched between the breast tissue and the pectoralis. If your plastic surgeon places “under the muscle,” the implant lies closer to the chest cavity, underneath the breast tissue and the pectoral muscle. The pectoralis major is separated from the rib cage at the bottom of the breast to create space for the implant.
There are pros and cons to both implant placements. Dr. Hubbard feels strongly that in most cases, placing breast implants under the muscle is a better decision.
There are five main reasons why placing the implant under the chest muscle is more ideal:
1. More natural look- An extra layer of tissue at the upper portion of the breast creates a smoother slope and reduces the risk of a “beach ball” augmented result.
2. Less rippling- Rippling is when you can see small the ripples or waves of the edge of the implant. Less rippling occurs with a submuscular implant because there is an extra layer of tissue covering the breast, especially in the cleavage area. There still can be rippling on the bottom or outside of the breast, because there is no muscle coverage there.
3. Better mammograms. It is easier to read a mammogram, and you get more accurate results when the implants lie below the muscle.
4. Lower chance of synmastia. When the implants touch in the middle of the chest it is call symmastia. This complication is very hard to fix once it has occurred. If the implants are placed below the muscle this complication is very rare.
5. Lowest risk of capsule contracture– Scar tissue forms around implants. This scar tissue is called the breast capsule. When this scar tissue grows too thick, it tightens causing a hardening of the breast known as capsule contracture. With silicone implants, placement under the muscle reduces the risk of capsular contracture by threefold. This is the most important reason to place the implant behind the muscle. Make sure you discuss capsular contracture with your plastic surgeon.
There are some disadvantages of placing breast implants “under the muscle” (submuscular):
1. It is a more painful surgery and has a longer recovery.
2. If you work out with weights a lot or are a body builder, the muscles “pecs” might squeeze the implant causing animation of the implants.
3. If you have loose skin or ptosis, placing an implant in front of the muscle might negate the need for a breast lift. If the implants are placed behind the muscle, a lift is more likely to be necessary.
If you believe that larger, fuller, or perkier breasts would improve your quality of life, call Dr. Hubbard’s office for a consultation. He and the entire staff of the Dallas Plastic Surgery Institute are friendly and professional, and will walk you through the process every step of the way.