Breast implant placement – in front or behind the muscle?

Breast implants can be placed either in front of or partial behind the pectoral muscle/breast muscle. Among both patients and surgeons there are divided opinions surrounding which method is most suitable. Like with other breast enlargement decisions, the decision is greatly influenced by the patients’ anatomical prerequisites and desires as well as the surgeons preferences.

The picture shows (a) pectoral muscle (b) placement of the implant in front of the muscle (c) placement behind the muscle

It can however be established that placement behind the pectoral muscle (breast muscle) is the most common choice for patients with a limited amount of existing breast tissue. This method is also known as submuscular or subpectorial placement.

The other option implies that the implant is placed behind the mammary gland but in front of the pectoral muscle, this method is also known as subglandular or submammary placement. In this page we will present the difference between both placement alternatives and their potential advantages and disadvantages.

Placing the implants behind the muscle

Placement behind the pectoral muscle is the most common breast enlargement method in patients with little or no existing breast tissue. The main advantage with this placement is that there is more tissue between the implant and the skin which provides a more natural result. Thus most cosmetic surgeons are in agreement that placement behind the pectoral muscle provides the most natural result for women with very little breast tissue.

Some surgeons consider this method to entail fewer infections since bacteria cannot reach the implants through the milk canals (ducts). There are also those who argue that the risk for so called capsule contracture (scar tissue that hardens around the implant) is less since the pectoral muscles movements massage the implant.

Breast enlargement surgery (breast augmentation)

Disadvantages of placement behind the muscle

Placement behind the pectoral muscle does have some disadvantages, although most are temporary. The discomfort after your breast augmentation is worse, as well as the swelling since the pectoral muscle must be loosened from its hold.

You may also perceive your breasts changing shape or position (distortion) for instance when exercising, performing certain movements with your arms or when sunbathing. The skin may then appear slightly wave-like/uneven within certain areas. In some cases the breasts shape and contours are affected by the pectoral muscles weight. This is known as muscle influence.

The risk of “bottom out”

If the plastic surgeon wrongly models the pocket in which the implant is to be fit there is a risk that the pectoral muscle presses the implant down. This condition is sometimes called ”bottom out” and gives the breast an unnatural fullness at the bottom which in turn makes the nipple point upwards.

Increased risk of damages to the implant

There is research that suggests the risk of damage to the implant, so called ruptures is higher with behind the muscle placement. According to the FDA the risk of rotation when using anatomical implants is also slightly higher with this method of placement. In both cases it is due to how breast muscles movement affects the implants.

Placing the breast implants in front of the muscle

The advantages of placing the breast implants in front of the muscle is that it implies less discomfort directly after your breast augmentation, less swelling and less risk of feeling your implants shift when exercising your upper body, for instance when lifting the arms over the head. The method also allows for larger implants.

A natural or provocative “look”

Most surgeons agree that patients with some existing breast tissue receive the most natural result when the implants are placed in front of the pectoral muscle, especially when using silicone implants. It is also possible to achieve greater fullness and pronounced shape in the breasts cleavage and upper part with this placement. For women who prefer a more “provocative” look placement in front of the pectoral muscle is preferred since the implants are more obvious and visible.

Better results in sagging breasts

Many surgeons consider placement in front of the pectoral muscle as the most suitable method for breast enlargements in patients with sagging breasts. This is because the pectoral muscle does not begin to sag in the same way as breasts do over time. In sagging breasts, if one places the breast implants behind the muscle there is a risk of them resting too high in comparison to the existing breast tissues position. This can result in an unnatural look whereby the breast tissue appears to sag below the firmer upper part of the implant.

Disadvantages with in front of the muscle placement of breast implants

According to some surgeons the disadvantages of placing the breast implants in front of the pectoral muscle is that the breasts obtain less support from the body which can cause them to begin to sag sooner than if they had been placed behind the muscle. Furthermore there is an increased risk of the outer edges becoming visible, especially among patients with little existing breast tissue since the implant is closer to the surface.

There is also a connection between so called traction rippling (more information about complications) and in front if the muscle placement. Most surgeons agree that the risk for rippling is greater when placing the implant in front of the muscle.

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