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Breast Implant Placement: Above or Below the Muscle

There are three planes used for breast implant placement to increase a woman’s breast size. These are: subglandular, subfascial, and submuscular. Within the anatomy of the chest are breast tissue/mammary glands, a layer of muscle called the pectoralis major muscle, and behind that another layer called the pectoralis minor muscle. Subglandular placement means that the implant is inserted directly behind the mammary gland and in front of both layers of muscle. Subfascial placement means that the implant is partially inserted under the fascia (the connective tissue) of the pectoral major muscle, but still above the muscle itself. Submuscular placement means that the implant is inserted under the pectoralis major muscle and above the pectoralis minor. Dual Plane means just that, as much as possible is placed under the pectoralis major muscle with some implant peeking out from the lower muscle edge under the breast tissue, as the muscle and breast borders are not always lined up.

implant placement

In general, the benefits of submuscular/dual plane breast implant placement are:

  1. Better superior (upper) coverage/hiding the implant in your cleavage where you will show them off the most

  2. Much lower rates of capsular contracture or scar tissue build up around the implant

  3. Most importantly, breast implants under the muscle do not interfere with your mammogram

Therefore, Dr. Feldman firmly believes that submuscular/dual plane implant placement is the best choice for overall patient health and optimal breast aesthetics. Addtionaly, he does not believe there to be any lasting benefit of subglandular (or sub fascial) placement. If your breasts are entirely below the muscle he will recommend a mastopexy (lift), not subglandular placement, to take advantage of the benefits mentioned above regarding submuscular/dual plane implant placement.

A submuscular implant looks better, feels softer for longer and doesn’t interfere with mammograms, giving you the best chance at early breast cancer detection and highest cure rate should it develop. However, it’s not always that simple. Many times the bottom edge of the pectoralis major muscle ends higher than your natural breast crease. If the placement of breast implants lies completely under the muscle it “rides high” and delivers a less than ideal aesthetic result, with your natural breast “falling off” the front of the implant. Therefore, to prevent that, Dr. Feldman frequently utilizes a dual plane implant placement. This means as much of the upper portion of the implant is under the muscle, for all the reasons listed above, but a small portion of the implant “peeks” out from under the muscle so the implant is nearly centered under the nipple. There are different degrees of dual plane release (I, II, III) but Dr. Feldman will do as little a release as possible to achieve an optimal aesthetic result, thereby leaving maximum muscle coverage.

Just about the only downside to putting implants under the muscle is what's called an animation deformity. An animation deformity is an expectation, not complication, with submuscular or dual plane implant placement. Every woman, worldwide, with breast implants placed under the muscle, regardless of surgeon, has some widening and distortion of her cleavage when flexing/engaging her pectoralis muscle. This change in breast and cleavage appearance with muscle contraction is known as animation deformity. In fact, when a patient can't remember where her implants were placed, Dr. Feldman will have her flex her muscle and watch her cleavage as a diagnostic test! How noticable this change with flexion is depends on how strong the pectorlis muscle is and where the bottom of the muscle was located relative to the natural breast crease. Ultimately, some distortion of cleavage, a few percent of the time when you're flexing your muscle, is far better than a permanent "bolted on" uber fake look, with visible 360 degrees rippling 100% of the time. Therefore, an animation deformity is a worthy tradeoff for all the abvementioned benefits of submuscular implant placement.


During your breast augmentation consultation Dr. Feldman will discuss breast implant placement options, and during the exam he will determine where your pectoralis major muscle ends compared to your breast fold to estimate the level of dual plane release required to optimize your breast appearance.

Learn more about the incisions to place your implant here!


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THE ALLERGAN RECALL OF BIOCELL TEXTURED IMPLANTS AND TISSUE EXPANDERS

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This July Allergan announced that it was recalling BIOCELL® Textured Breast Implants and Tissue Expanders. With the recent coverage of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in the news, some of our patients are searching for more information about the safety of breast implants. Learn more about the Allergan recall, Bancroft Feldman's policy on using textured implants, and what our patients' options are.

What Our Patients Are Saying

LG, Houston, TX

"I'm unable to think of a better word to describe the result of my breast augmentation result than "perfect". I'm literally IN LOVE with the outcome. I have named my left breast Sonya and my right breast Sally because, now, they actually look like beautiful sisters instead of EXTREMELY distant cousins...

The entire staff was incredibly amazing, knowledgeable, patient, and polite. Each staff member took EXTRA care to make sure I was comfortable and well taken care of. Everyone went ABOVE and BEYOND by always politely greeting me upon my entrance into the waiting area and the patient room, providing adequate amount of pain medicine - specifically the generic brand to cut cost, slightly numbing my hand with topical wipe to prevent sharp pain upon I V placement, answering any and all questions, and making specially arrangements to accommodate schedule changes.  

Upon entry to the surgical room, the nurses and the anesthesiologist provided EXCELLENT bedside manner with added humor, comfort, and positive personalities. The anesthesiologist even added medicine to my I V to help with my skin condition. ALSO, someone even made sure the pillow my feet were placed on was warm. OMG! AHHHHHHH-MAZING! 

Moreover, my breast are healing wonderfully. The office reverberates a youthful and inviting vibe and the staff seems like a tight-knit family that works well together. I returned Dr. Feldman's missed call last week just to say thank you; to him and all of his perfectly picked staff. Due to being the TOP breast surgeon in Houston, I understand he is busy so I figured I'd shoot a quick e-mail. 

Thank you EVERYONE for making my breast augmentation TOTALLY AWESOME in all aspects."

 

KL, Humble, TX

"Everyone was so welcoming and confidient in Dr. Feldman’s work. The staff was also very helpful and prompt with any questions I had. The office and OR looked very professional and classy, very modern. The price was great but Dr Feldman and his staff sealed the deal. This was my first and last breast augmentation consultation."

DH, Katy, TX

"I am so pleased with the exceptional bedside manner of Dr. Feldman. I initially went to him for Botox and recently decided on getting a breast augmentation. I am so pleased with the work and skills that Dr. Feldman has offered me. I have already recommended most of my friends and family. The office is in a great location and the staff is incredible. If you are interested in the best breast out there, Dr. Feldman is the right choice."