Breast Implant Placement Options: Over-the-Muscle vs. Under-the-Muscle

When considering breast augmentation, one of the most pivotal decisions made is the placement technique for your breast implants. Both options — over-the-muscle (subglandular) and under-the-muscle (submuscular or dual-plane) placement — each come with their own set of benefits, risks, and aesthetic implications. Understanding the differences between these approaches is essential to achieving the most natural-looking, satisfying, and long-lasting results for your individual anatomy and lifestyle, which is why Wichita plastic surgeon James Shaw, MD delves into each technique below.

Subglandular (Over-the-Muscle) Placement

In the subglandular technique, the implants are positioned directly behind the natural breast tissue but in front of the pectoral (chest) muscle. This method can be advantageous for women who already have a sufficient amount of natural breast tissue to cover and support the implant. Since the muscle is not manipulated, recovery time is typically shorter and post-operative discomfort may be less intense. Moreover, patients who are physically active, particularly bodybuilders or weightlifters, may prefer this method to avoid potential distortion of the implants during chest muscle contractions.

The outcome of subglandular placement can be excellent, particularly when the implants are modest in size and a patient has enough natural tissue to create a smooth contour. The breasts may appear more rounded and prominent, which is a look some patients desire. However, this approach can carry a relatively higher risk of visible rippling — especially in thinner patients — since there is less tissue covering the implant.

Submuscular (Under-the-Muscle) Placement

Submuscular placement involves inserting the breast implants beneath the chest muscle. This method is typically the most commonly utilized and provides more coverage for the implant, which is particularly beneficial for women with minimal natural breast tissue. By placing the implant under both the muscle and breast tissue, the edges of the implant are less likely to be visible or palpable, resulting in a more natural look and feel. Additionally, the added tissue coverage tends to reduce the risk of rippling and can decrease the incidence of capsular contracture compared to an over-the-muscle approach.

Which Technique is Best for Mammograms?

One of the other significant advantages of submuscular placement is the improved visualization of breast tissue during mammograms. Since the implant is located beneath the muscle, radiologists have a clearer view of the breast tissue, which can enhance early detection of abnormalities. However, this technique does involve a slightly longer and potentially more uncomfortable recovery, as the muscle must be manipulated during surgery. Patients may experience soreness for a longer period, and full physical activity may need to be postponed for several weeks.

Factors to Consider in Choosing Placement

The decision between over-the-muscle and under-the-muscle implant placement is not one-size-fits-all. Several factors must be taken into account, including: 

• Natural anatomy
• Your lifestyle
• The desired aesthetic outcome
• Future plans, such as pregnancy or weight changes

For example, patients with thinner frames or minimal breast tissue may be better suited to submuscular placement to ensure adequate coverage and a natural contour. Those with more robust breast tissue and a preference for a fuller, rounder upper-pole look may be ideal candidates for the subglandular approach. Your activity level is another key consideration — those who engage in intense physical activity involving the chest muscles may experience “animation deformity,” where the implants move unnaturally with muscle contractions. This is more common with submuscular placement.

Additionally, long-term considerations such as future breastfeeding and mammogram screenings should be discussed during the consultation. While both techniques can preserve breastfeeding ability, submuscular placement is generally thought to have a lesser impact on mammograms.

Dr. James Shaw can personally walk you through every stage of the breast augmentation process so you can make the best decisions to achieve the custom breast contours you envision. His priorities are making sure you feel supported and informed throughout treatment, so don’t hesitate to contact Shaw Plastic Surgery today for more information.