Breast implant placement options: under vs over the muscle

Breast implant placement is one of the most important decisions in breast augmentation surgery, as it significantly impacts the appearance, feel, and long-term outcomes of the procedure. In Riyadh, as in other parts of the world, the two primary options for implant placement are subglandular (over the muscle) and submuscular (under the muscle). Each approach has distinct advantages, considerations, and implications for recovery, aesthetics, and potential complications. Understanding these differences helps patients make an informed decision in consultation with a qualified plastic surgeon. 1. Subglandular Placement (Over the Muscle) Subglandular placement involves positioning the breast implant above the pectoral muscle and directly beneath the breast tissue. This approach is sometimes referred to as “over the muscle” placement. Advantages of Subglandular Placement Shorter recovery period: Because the chest muscle is not disturbed, patients generally experience less post-operative pain and recover more quickly. Easier surgical procedure: The surgery is less invasive, making it faster and simpler to perform. Fuller upper breast appearance: Over-the-muscle placement often creates a more prominent upper breast volume, which some patients prefer for a more pronounced cleavage. More predictable sizing adjustments: Surgeons can more easily adjust implant size and positioning during surgery because the muscle does not restrict placement. Considerations Less natural contour in thin patients: Women with minimal natural breast tissue may notice more visible implant edges or rippling. Higher risk of capsular contracture: Scar tissue can form more tightly around implants in over-the-muscle placement compared to under-the-muscle placement. Potential interference with mammograms: Implants placed over the muscle may slightly obscure breast tissue on mammograms, though modern imaging techniques can compensate for this. 2. Submuscular Placement (Under the Muscle) Submuscular placement involves positioning the implant beneath the pectoralis major chest muscle. This approach is sometimes called “under the muscle” or dual-plane placement if the implant partially extends under the breast tissue. Advantages of Submuscular Placement More natural contour: The muscle provides extra coverage over the implant, making the breast appear softer and reducing visible edges or rippling, particularly in women with thin tissue. Lower risk of capsular contracture: Placing the implant under the muscle has been shown to reduce the likelihood of scar tissue tightening around the implant. Better long-term aesthetics: Submuscular implants are less affected by gravity over time, helping maintain breast shape and position. Improved mammogram visibility: Implants under the muscle create a clearer separation from breast tissue, allowing more accurate imaging for cancer screening.