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Breast Implants: Under the Muscle or Over the Muscle


Under the Muscle Versus Over the Muscle, Understaning the Choices

Once you’ve already determined that you’re going to have breast augmentation surgery, an important question to consider is whether or not the implants should be surgically placed underneath the muscle or over the muscle.  The implant can be placed in either location or even partially under the muscle.  Where the implant is placed affects the shape and health of the breast afterward.  In this article, we will discuss the pros and cons of each method: over the muscle placement, partially under the muscle placement, and completely under the muscle placement. 

Over the Muscle

Placement of breast implants over the muscle puts the implants directly next to the breast tissue.  In order words, the implant is inside the breast rather than beneath it.  This can create a rounded look that some women desire, though the appearance is less natural looking.  For women who desire a significant breast augmentation, this is commonly how the implant is placed in the breast.  The procedure to place the implant over the muscle is easier than underneath the muscle, and therefore nearly any plastic surgeon can accomplish the surgery. 


Additional benefits include the fact that the post operation recovery is easier to deal with because only skin and fat are cut rather than muscle.  However, there are some disadvantages of placing the implant over the muscle.  One is that it interferes with the results of mammograms.  Also, the implant can sometimes be seen and felt from the outside, particularly if it is textured or if it ripples.  Another disadvantage of placing the implant over the muscle is that there is a higher rate of capsule contracture, where the body reacts negatively to the foreign material inside it.  The immune system may see the implant as a threat, so the collagen-fiber capsules tighten and squeeze the implant.  This can be quite painful and cause an abnormal appearance.  Lastly, with over the muscle placement there is a higher rate of the implant migrating downward in the future.

Partially Under the Muscle

Sometimes the surgeon will place the implant partially under the muscle using an areola incision or inframmamary crease incision.  Thus, the implant is mostly behind the breast, which means that there are not complications with mammography and the appearance is more natural.  However, the post operation recovery is more difficult and the technical skill for the surgery is more demanding.

Under the Muscle

Placing the breast implant completely under the muscle is the last way of inserting an implant into the breast.  The implants are completely behind the breast in this case.  With this method, the muscle support fascia holds the implant more in place to prevent it from bottoming out.  Advantages include the natural shape it provides including no rippling, ease of placement, lower risk of capsule contracture, low interference with mammography, no scars on the breast, good support, and no damage to the ducts during placement.  However, this procedure is difficult to master (not all surgeons are capable) and takes much longer to recover from after the breast augmentation surgery. 

Under the Muscle vs Over the Muscle

In today’s world, it is more common to have breast implants be placed under the muscle to create the optimal natural appearance of larger breasts.  Under the muscle also has advantages in that it is less likely to cause capsular contracture or complications with mammography.  It is important to thoroughly discuss your options with your plastic surgeon to determine which method will be best.  The appearance you seek, the lifestyle you live, and your medical history are all going to be important factors in determining the preferred method of implant placement.  In many cases, under the muscle will prove to be the better method; this is why it is the more popular or more commonly used procedure.  Unfortunately, it takes more specialized skills to perform the under the muscle method than the over the muscle method.  On the other hand, since the procedure affects so much of the woman’s life and how she views herself, many women will say that the work to find the right surgeon and the travel to meet with him or her is well worth the sacrifice. 


Breast Surgery Index
Should you get Breast Implants Silicone Implants Silicone vs. Saline Implants
Choosing the Right Size Under or Over the Muscle Gummy Bear Implants
High Profile Implants Mentor Implants Most Popular Implants
Plastic Surgery of the Breast Reasons for Breast Reduction Stem Cell Breast Augmentation
Breast Lift Breast Reduction Breast Augmentation Cost



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