In today’s world and with easy access to information, many patients come to their consultation appointment with a wealth of knowledge about the procedure they are interested in. I think it’s great that patients can be so well-informed as it places them in a good position to take an active role in the decisions made about their procedures. When meeting me for the first time in a consultation appointment they can ask targeted questions such as, “Should I have my implants placed over top of or underneath my chest muscles?,” which is an important question that commonly arises.

The highly personalized nature of aesthetic procedures means that there is not necessarily one single answer to this question that will apply to all patients. Breast augmentation is a surgical procedure that is particularly individualized, having unique factors affecting the implant placement such as the patient’s body type, how much breast tissue is present, and implant size, type and shape. There are advantages and disadvantages to each decision, which makes the best decision the one that is ideal for the individual patient’s circumstances.

There are a number of benefits to placing an implant below the pectoralis (chest) muscles. It can promote a more natural breast contour, particularly in patients who lack a lot of breast tissue or fat. In extremely thin patients, there can be a risk of rippling where the implant causes visible folding and wrinkling at the skin, and placing the implant below the muscle can help mitigate this risk. Submuscular implants can also reduce the rate of capsular contracture, a condition where a specific type of scar tissue forms around an implant. 

On the flip side, there can be some cons to placing implants below the muscle. Most prominently, there is greater discomfort associated with the postoperative recovery period. While longer than the alternative operation, this discomfort is short-lasting and can be managed with medication. In some patients who do significant weightlifting, repeated and strong flexing of the chest muscles may cause the implant to become distorted in shape. With age, there is some risk of breast tissue sagging below while the implant stays held in place.

Breast implants can also be placed over top of the muscle, below breast tissue. This procedure, known as subglandular breast implant placement also has a number of associated benefits. Recovery can be less painful and shorter in comparison to below the muscle. When placed over the muscle, there can be a slight and subtle lift for sagging breasts. Natural results can last for years, as the implant will parallel the breast’s natural descent downward with time. For those who participate in activities that greatly strengthen the chest muscles, this option may be better suited as there is less risk of distorting the implant and overall shape of the breast. It is more feasible to place larger implants with this method, which may be beneficial for those seeking a dramatic change.

This implant placement also has some downsides. Concerns include that in the extremely thin patient there can be an increased risk of rippling, and the risk of capsular contracture is higher. In cases where skin lacks sufficient elasticity or improper placement during surgery, there is risk that the implant may drop too low on the chest wall.

If you are considering breast augmentation this article is not meant to make your decision, but rather give a general overview of what is involved with different implant placements. As an experienced plastic surgeon, I can help assess your body, understand your unique circumstances and goals, and work with you to help make the choice.

Dr. Arjang Yazdani, BSc, MD, FRCSC