The Approach: Above or Below the Muscle

If you are considering breast augmentation, the approach you take for the placement of your implant is one of the biggest decisions you will make. Specifically, using an above or below-the-chest muscle approach can and will have a huge effect on your results, almost as much as which implant you select.  So, it is important to select a surgeon who tailors this approach to your anatomy and overall aesthetic and life goals. 

Two main options for placement of your implant 

Placing your implant under the muscle requires a slightly more invasive procedure but typically yields a better shape.  It also works better when it comes to breast imaging tests like mammograms.  However, placing the implant over the muscle may result in less immediate postoperative pain while still offering satisfying aesthetic results. Let’s take a look at the pros and cons of each:

Subglandular (above the muscle):

  • More natural appearance since your implant has room to settle and slide down naturally, unrestricted by your chest muscle and the deeper soft tissue 
  • Reduced postoperative discomfort since this is a less invasive approach and your chest muscle is not disturbed
  • Avoid an “animation” aka “window shading deformity” where your implants shift or distort oddly when you flex your chest muscle

However, subglandular placement also comes with some notable drawbacks:

  • Higher risk of capsular contracture, aka scar tissue, which tightens around your implant leading to the hardening of your breast and visible asymmetry
  • Since the implant is closer to your skin, your implant will be more noticeable, which in some cases can lead to visible rippling and wrinkling

Submuscular (below the muscle):

  • Placing the implant underneath your chest muscle will reduce the risk of capsular contracture, aka scar tissue, forming around your implant
  • The risk of having noticeable implant show-through after your surgery is much lower, especially when it comes to visible rippling and wrinkling
  • Provides more coverage and support for your implant, especially in the upper half of the breast, above your nipple and areola 

The tradeoffs with submuscular placement include:

  • Immediate postoperative pain and achiness can increase, including a risk of chest muscle spasms in the first week or two after surgery
  • Disrupting the muscles means that you will have a longer time to return to normal activities, including the gym and with upper body exercises 

Chose the approach that is right for you

Both of these options have compelling pros and cons. But which approach is right for you? It is important to make the choice that fits your body and lifestyle. A majority of our patients choose a below-the-muscle approach. They like the idea of having a more youthful breast shape, with less implant show and a lower risk of scar tissue formation after surgery.  But, that doesn’t mean that some of our patients don’t prefer the more natural results from an above-the-muscle approach with the bonus of slightly less recovery. And some of our body-building patients prefer this approach since it doesn’t disrupt the chest muscle which can be important for their performance.  As the reasons can vary, it is important to educate yourself on these options before going through with surgery. If you have questions or want to discuss your unique needs, please reach out. We are here to help explain the technical details of this surgery, especially when it comes to our approach to implant placement, in an easy-to-understand way.  We will guide you through this decision and ensure that you feel confident with your choice and satisfied after surgery.