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Size is often one of the first things many patients think about when they start planning their breast implant surgery. While the volume of implants matters, it is only one part of the decision. Choosing between implants placed over the muscle or under the muscle affects the appearance of the breasts as well as recovery time and movement after surgery. This decision is a personal one that should be talked about in detail with your surgeon. Dr. Karol A. Gutowski is a board-certified plastic surgeon who works with each of his patients in Chicago to find the right placement.
Sometimes the implants are positioned on top of the chest muscle and beneath the breast tissue. These implants sit closer to the surface of the breast and there is less interaction with the chest muscle during surgery.
With under-the-muscle placement, the implant is positioned partially or fully beneath the pectoral muscle. The muscle sits on top of the implant and puts an additional layer between the implant and the skin. During this surgery, a pocket is made in the pectoralis major muscle, which keeps the implant in a stable position.
Implants placed above the muscle tend to sit more forward on the chest because there is no muscle layer covering them. This can lead to a rounder look, especially in the upper portion of the breast, which some patients prefer. Breast augmentation over the muscle may make the implant edges more noticeable when leaning forward or lying down.
When implants are placed under the muscle, the upper portion of the breast is shaped in part by the muscle itself. With this type, the transition from the chest to the breast may look smoother, particularly for patients who have less natural breast tissue to cover the area.
Implants positioned over the muscle may be more noticeable to the touch because they are covered only by breast tissue and skin. In patients with thinner tissue, the implant surface can be easier to detect during physical contact. With under-the-muscle placement, the implant has an additional layer of coverage from the pectoral muscle for a smoother feel in the upper breast.
Implant edges and rippling are more likely to be visible when there is less tissue covering the implant. This can occur with both placements, but is more common with implants over the muscle. Patients with thinner breast tissue may need to consider under the muscle placement to reduce rippling.
When implants sit over the muscle, they remain relatively stable during chest muscle use. Activities like weightlifting or pushing movements usually do not cause visible implant movement. This can matter for patients who frequently engage their chest muscles.
With under-the-muscle placement, the implant can shift temporarily when the pectoral muscle contracts. This movement is most noticeable during flexing or certain exercises. Some patients are bothered by this, while others are not.
Recovery after over-the-muscle placement often involves less muscle-related soreness since the chest muscle is not lifted. Discomfort is typically focused in the breast tissue itself and range of motion may return sooner for some patients.
Under-the-muscle placement involves healing of both breast tissue and muscle. Early recovery can include tighter sensations across the chest and temporary limitations with arm movement. Muscle involvement can extend the adjustment and healing period.
Breast implant placement depends on a combination of anatomy, tissue characteristics, and how your chest muscles function. Two patients with the same implant size can have very different outcomes based on how much natural tissue they have and how their body heals. Preferences about movement and feel also vary from person to person. Dr. Gutowski evaluates placement on an individual basis, considering all of these factors.
Dr. Karol A. Gutowski is a board-certified plastic surgeon with extensive experience in aesthetic procedures involving the breast, body, face and skin. His background includes fellowship training and leadership roles at major academic medical centers, along with authorship of more than 100 peer-reviewed publications on plastic surgery topics. He is nationally recognized for his work in breast surgery and has contributed to professional guidelines and safety initiatives within the field.
Choosing implant placement affects how the breasts heal, move and look, which is why understanding options like breast implant placement can help set realistic expectations before surgery. At Dr. Karol A. Gutowski in Chicago, IL, we work hard to find the surgical technique that best suits each patient. To discuss your options further, complete the online form or call 847-906-1527 to take the next step.
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