Breast Implant Positioning

By Dr. James White

While many cosmetic surgery candidates assume breast implant size is the only variable in breast augmentation outcome, they are misinformed. Breast implant type, shape and positioning also play an important role in breast enhancement cosmetic results.

Although a fair amount of patients are aware of the pros and cons of implant type (saline or silicone?) and size (small “C” cup or DD?), a vast majority of patients do not realize the role implant placement plays in the overall aesthetics of breast enhancement. In fact, breast implant placement can be executed through several different approaches. Primarily, they can be placed completely under the muscle (subpectoral), over the muscle subglandular or partial sub muscular (dual-plane).

Under the Muscle/Subpectoral

When a surgeon refers to “subpectoral” or “under the muscle” placement, this typically implies that the implant will be placed completely beneath the pectoralis muscle. This technique can be advantageous particularly for women with extremely thin tissue as this type of placement allows the entire implant to be camouflaged and padded by overlying muscle and existing breast tissue. As a result, wrinkling and rippling of the implants less likely. In addition, this technique greatly reduces the likelihood for capsular contracture (hardening of the breast due to the abnormal development of scar tissue of the capsule around the implant). Although this techniques has many advantages, it can cause more immediate postoperative discomfort and require longer recovery time than subglandular placement. Flex of the pectoralis muscle with submuscular implants can cause implant distortion.

Over the Muscle/Subglandular

Subglandular placement is executed by placing the implant over the pectoralis muscle directly under the breast tissue . While this technique may not require as long of a recovery and less postoperative discomfort as subpectoral placement, the chances for capsular contracture are greatest with this approach. At our practice, subglandular placement is not the preferred method not only due to potential for capsular contracture but also because of the potential for visible implant rippling and a less natural feel of the breast implant. However, it can prove beneficial for extremely athletic patients such as bodybuilders who are more susceptible to muscular distortion which can occur when the implant is placed under the muscle.

Dual-plane/Partially under the muscle

When a patient exhibits a slight droop of the breast, often due to deflation of the breasts after a pregnancy or weight loss, yet still possesses good skin quality, we often prefer to perform a dual-plane breast augmentation. A dual-plane placement allows for the upper portion of the implant to be covered by the pectoralis muscle while the lower portion of the implant is only subglandular. This technique provides a gentle lift, without the need for a more invasive breast lift and the scarring and discomfort that a formal breast lift entails. Even better, this technique still has a low likelihood of capsular contracture formation, the best of both worlds.

In order to accurately determine the most beneficial placement for your unique body, it is necessary to consult with a Board Certified Surgeon experienced in breast augmentation surgery. To book a private complimentary consult with our Board Certified Surgeons, call 423-648-4011.