When considering breast augmentation, choosing the implant itself is only part of the decision. Another important factor is where the implant is positioned in relation to the chest muscle.
Breast implants can generally be placed either over the pectoralis major muscle or partly beneath it. The most suitable option depends on your anatomy, the amount of natural breast tissue you have, the look you would like to achieve and a number of surgical considerations.
What Does “Over the Muscle Implants” Mean?
Over-the-muscle placement is usually known as subglandular placement. The implant is positioned behind the breast tissue but in front of the pectoralis major muscle.
Because the chest muscle is not lifted to accommodate the implant, this approach may involve less muscular discomfort during the early stages of recovery. It also avoids the animation deformity that can occur when the pectoral muscle contracts over an implant positioned beneath it.
Over-the-muscle placement can work particularly well for patients who already have enough natural breast tissue to provide good coverage over the implant. However, in patients with relatively little breast tissue or body fat, the implant edges may be easier to see or feel, and rippling can sometimes be more noticeable.
What Does “Under the Muscle Implants” Mean?
The phrase “under the muscle” can be slightly misleading. In modern breast augmentation, it often refers to a dual-plane or partially submuscular technique, rather than placing the entire implant beneath the pectoralis muscle.
With a dual-plane approach, the upper part of the implant is covered by the pectoralis major muscle while the lower part sits directly behind the breast tissue. This can provide additional coverage across the upper breast and may help disguise the edges of the implant, particularly in slimmer patients.
The trade-off is that the pectoral muscle can influence the implant. When the muscle contracts, some patients notice temporary movement or distortion of the breast, known as animation deformity. Recovery can also feel tighter or more uncomfortable initially because the muscle has been involved in the operation.
Which Placement Looks More Natural?
Neither placement automatically produces a more natural result.
The final appearance depends on several factors, including your existing breast shape, skin quality, chest width, amount of breast tissue and the size, shape and profile of the implant selected.
For someone with limited natural breast tissue, additional muscle coverage may help create a smoother transition across the upper part of the breast. For someone with more tissue coverage, an over-the-muscle implant may also produce a soft and natural-looking result without involving the chest muscle.
Are There Different Risks?
All breast augmentation surgery carries potential complications, regardless of implant position. These can include bleeding, infection, changes in nipple or breast sensation, implant rupture, asymmetry, implant displacement and capsular contracture.
Capsular contracture occurs when the scar tissue that naturally forms around a breast implant tightens and becomes unusually firm. Research suggests that subglandular placement may carry a higher risk of capsular contracture than submuscular or dual-plane placement, although implant type, surgical technique and individual patient factors can also influence risk.
Under-muscle placement has its own considerations, particularly animation deformity and muscle-related movement of the implant. This is why the choice of implant position needs to be made on an individual basis rather than assuming one technique is better for everybody.
How Is the Right Position Chosen?
During your consultation, I assess factors such as the thickness of your existing breast tissue, chest anatomy, skin envelope, breast position and the result you are hoping to achieve before recommending an approach.
Implant choice is considered at the same time. Whilst there are many different types of breast implants, we use MENTOR breast implants, with the implant size and profile selected to suit the individual patient rather than taking a one-size-fits-all approach.
The aim is not simply to choose between “over” or “under” the muscle, but to select the combination of implant and surgical technique that best suits your anatomy and aesthetic goals.
If you are considering breast augmentation, your consultation is an opportunity to discuss the different implant positions, understand the advantages and limitations of each, and decide which approach is most appropriate for you.
