NEVER?! Ok, almost never. There is one exception. More on that later.
The muscle involved in a breast augmentation is pectoralis major muscle. It starts at your shoulder and fans out across your chest attaching to your clavicle and your sternum. [Photo] It sits right underneath your breast. The pectoralis major is the key player with regards to placement of the implant in a breast augmentation procedure. Your plastic surgeon can make a pocket underneath the pec muscle instead of inserting the implant directly underneath your breast. Placing your breast implant underneath the muscle gives the best breast augmentation result. Here’s why:
- Your pec muscle adds another layer of soft padding over the breast implant. This invariably gives you a more natural-looking breast augmentation. It makes it harder to see the edges of the implant. It minimizes implant rippling. It makes the implant hard to feel. Also, the top and bottom of your breast transition more smoothly off your chest when your breast implant is under the muscle.
- With your breast implant under the pec muscle, the muscle itself holds the implant in place, providing stable support, giving breast augmentation patients a much better result over the long term. Because muscle is strong and stable, it holds the implant in position well. Breast tissue, as we all know, stretches and sags. It can also thin and weaken over time. Placing an implant over the muscle exacerbates and accelerates stretching and sagging by taking a breast that might naturally sag a little and adding a weight to it. The result is completely predictable. [Photo of this problem] You need the pec muscle to lock in the breast implant.
- Breast implants placed over the muscle prevent good mammograms. Implants under the muscle do have a mild impact, but it’s nothing a trained mammographer can’t compensate for. Studies also show that subpectoral implants do not delay the diagnosis of breast cancer. Subglandular implants (over the muscle) do. This alone is reason enough to avoid putting breast implants over the muscle.
Except maybe in one case - competitive bodybuilders.
Breast implants that are placed over the muscle can animate, meaning that when you flex or contract your pec muscle, the implant moves a little. For most women, the movement is slight, and it’s at most, a minor issue. But for a bodybuilder, this might be a problem in competition. Also, as bodybuilders weight train, the heavy weights they repetitively lift may shift the implants over time, moving them outward to the sides of the chest.
I tell my bodybuilder patients to consider putting their breast implants on top of the muscle, but that’s not exactly a perfect solution. Bodybuilders have minimal body fat and typically little breast tissue. This can make the edges of a subglandular implant very visible. So whether or not to place the implant above or below the muscle is something decided on a case-by-case basis.
Over the course of 20 years and thousands of breast augmentations, this concern has surfaced just a handful of times. It probably doesn't apply to you. Put your implants under the muscle.
For more information about breast implants, contact our Dallas office to schedule your appointment with board-certified Dr. Schwartz.