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Breast Augmentation - Implant Placement Options

Where Are the Implants Placed with Respect to the Breast?

Placement of breast implants, either under or over the Pectoralis Major or chest muscle has important consequences.

Subpectoral: "Under the Muscle"

In Subpectoral placement, the breast implant is positioned under the Pectoralis Major muscle and directly over the rib cage. In this circumstance, the lower part of the implant is not covered by any muscle. This is preferred by many surgeons because it creates a more tear drop breast shape. On the other hand, some surgeons prefer submuscular implant placement, where the implant is entirely covered by the chest muscles. Another disadvantage of submuscular placement is that flexing of chest muscles during exercise can contract the implants or push them in and out of place. Furthermore, the breasts will have a flatter shape, and at times will show a double-bubble deformity, where the periphery of the implant appears separate from the breast.

Subglandular: "Over the Muscle" Through this method, the implant is placed above the chest muscle, but below the mammary gland. This is a less complex surgery, with less pain and a somewhat shorter recovery. Some surgeons prefer this method because of its ease and speed of implant placement as well as a shorter period of time that it takes for the implants to settle.

Advantages & Disadvantages of subpectoral vs. subglandular implant placement

The main advantages of submuscular or Subpectoral implant placement as compared to subglandular placement are:

  1. Lower Risk of Capsular Contracture: (3% vs. 30%) The body builds a scar capsule around any foreign material including a breast implant. This capsule is usually very thin and soft in the submuscular/subpectoral pocket. On the other hand this capsule can become very hard and thick in the subglandular pocket causing the implants to become very hard and spherical. In severe cases, this can cause much pain and deformity, requiring removal of the implant from the subglandular pocket and placing them in the subpectoral/submuscular pocket.
  2. Less Sagging of Breasts: The Pectoralis Muscle tends to hold the breast implants up and prevents them from sagging.
  3. Less Visible or Palpable Rippling: Although all saline implants do ripple, their placement under the muscle will better camouflage them.
  4. Better protection of the Implants: In case of the need to perform breast biopsy or surgery on the breasts.
  5. More Natural Shape: Pectoralis Muscle pads the upper pole of the implants, therefore, making the upper breast slope appear more smooth and gradual.
  6. Less Obstruction of the Breast Tissue with Mammogram. Placement of the implants away from the breast tissue and under the muscle interferes less with mammography and breast examination.

Disadvantages of submuscular or subpectoral implant placement as compared to subglandular placement is:

  1. Implants take longer to drop or settle after surgery.
  2. Possible creation of a Double-Bubble deformity in sagging or ptotic breasts. Because implants are held up by the muscles, the sagging breast tissue can hang over the implant as a separate entity. This can give the appearance of a double-bubble. This can be avoided by lifting the sagging breast tissue and centering it on the breast implant.
  3. More post-operative pain. As a rule, the difference in the degree of pain is insignificant.

During your consultation with Dr. Younai he reviews your treatment options and choices of different Techniques and Location of implant placement, including pros and cons of each techniques, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. You will also have an opportunity to "try on" different types of saline or silicone breast implants. There are also many before-and-after pictures and high resolution images of breast augmentation available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.




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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.
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