Placement Breast Implants: Behind or in Front of the Muscle?
Most of us are familiar with the pectoralis muscle, the large muscle between the breast and the chest wall that attaches to the upper arm. Breast implants can be placed behind the breasts in front of this muscle. This is called subglandular placement. Alternatively, the breast implants can be placed behind the muscle between the muscle and the chest wall. This is called submuscular placement.
The advantage of submuscular placement is that the final breast shape tends to look more natural. The upper pole is full but more sloped and less rounded. With submuscular placement, the pectoralis muscle is not "damaged" and there should not be any significant weakness of the muscle
Another advantage is that the incidence of capsular contracture or hardening of the breast implant is lower with submuscular placement of the breast implants.
Submuscular placement of the breast implants also makes mammogram interpretation easier and more accurate which is an important consideration in women, especially those women with a family history of breast disease.
A disadvantage of submuscular placement is that with exercise or contraction of the pectoralis muscle, the implants will "move" but will then return to the original normal position once the muscle relaxes.
The advantage of subglandular placement of the breast implant is that the surgery is less painful and there is no disturbance of the muscle. The breast implants will not move with muscle contraction.
One can still achieve a natural look with subglandular placement of the breast implants provided that the required breast implants are not excessively large.
For patients who exercise frequently such as professional body builders, subglandular placement of the breast implants is often recommended. However, there are many patients who exercise vigorously or are involved in triathalons that choose to have their breast implants placed submuscularly and still they do very well with the implants in this position.
Most women today choose to have the breast implants placed submuscular or behind the muscle although each individual situation must be analyzed carefully to determine the best approach.