Breast Implants, Above Vs. Below The Muscle
Saline and silicone implants can be placed either in the subpectoral (below the muscle), dual plane, or subglandular (above the muscle) position. The plane of dissection normally depends on each woman’s chest wall anatomy. For the majority of women, we do prefer to place the implants with the dual plane technique, where the implant is two-thirds under and one-third over laterally. The reason for two-thirds is that the lateral third of the pectoralis muscle is the oblique orientation, and there is no true muscle cover on the lateral portion of the breast. We do not use the serratus anterior muscle in cosmetic surgery, normally in order to place the implant in the complete submuscular pocket. Therefore, the majority of my patients undergo the dual plane technique, which is considered “under the muscle.” Women who are thin (ectomorphic) with minimal breast tissue should have submuscular cover to reduce visibility and palpability of the implant edge.
Indications for subglandular (above the muscle) implant placement are women who have very thick chest walls, endomorphic appearance, barrel chest deformity, or very thick amounts of breast tissue and/or muscle. If you put the implants submuscularly in these women, the implants tend to have a very flattened appearance, and the women are often very unhappy with the final appearance. Their breasts lack the fullness of the upper pole, and patients often will want revision surgery. After having placed thousands and thousands of implants, I have been able to obviously determine which patients do well with implants above the muscle. Those are often thick-chested women who do possess upper pole fullness and, therefore, an implant should be placed above the muscle in order to prevent effacement of the upper pectoralis major on the upper pole of the breast implant. When implants are placed above the muscle on revision, I will often maintain the same pocket in dissection. Sometimes the capsule can be used in order to create more coverage, and sometimes the neo plane can be developed by elevating a small portion of the medial muscle, lifting it and suturing it to the lower capsule; however, this not always possible.
In summary, implant placement in the submuscular vs. subglandular position depends on each individual woman’s anatomy, amount of breast tissue, and also preference of the final appearance of the breast. In general, in thinner women, a more natural appearance is accomplished by placing the implant using the dual plane technique or submuscular.
To schedule your consultation with Dr. Linder and learn more about breast augmentation or saline or silicone implant placement, call our office at 310-275-4513 in Beverly Hills or fill out our online contact form today.