Implants and muscle placement, what position is best?

Breast implants can be placed either under or over the pectoralis muscle. In the United States and at Synergy Plastic Surgery we typically place all of our breast implants into a submuscular (under the muscle) position.  This is done for many reasons but the most important ones are that the muscle helps to better cover the implant and results in a clear reduction in the risk of capsular contracture.

From an anatomical perspective placing a breast implant under the muscle means there is more tissue between the skin and the implant.  This gives the implant a more natural slope and shape and helps to significantly decrease the risk of visible implant rippling in thin patients with little natural breast tissue.

With regard to capsular contracture the submuscular position has been studied for decades.  Studies have shown that shielding the implant from the breast tissue by leaving the muscle between the two reduces the risk of scarring that can lead to a firm or harder breast than desired.  Historically we have seen a reduction from approximately 20% of patients with implants just below the breast tissue to as low as 2% for submuscular implants.

All patients with submuscular implants will be able to move their implants somewhat with muscle contraction.  To limit the visibility of this action I always recommend to patients that after augmentation they don’t do specific exercises to target building the pectoralis mucle.  This simply means limiting exercises such as pec deck and bench press after surgery in order to prevent the muscle from becoming too strong.

If you would like to learn more about breast augmentation and implant placement techniques please come visit us at our Austin, Texas plastic surgery practice for a complimentary consultation.  I am happy to spend time discussing the options which best suit your body type and how breast augmentation can enhance your overall life.

-Mahlon A. Kerr, MD, FACS

Diplomat, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Fellow, American College of Surgeons