How do I know if I want my breast implants placed over or under the muscle?

Question:  I want a breast augmentation so that I can finally look good in my swimsuit.  However, a friend had implants.  It was incredibly painful and she looks ridiculous – her implants are half way up her chest and her natural breast hangs below it.  Is this the way they are supposed to look?

Answer:

No, it is not how the result should look.  But under-the-muscle implants hurt a lot the first week after surgery and can take up to 6 months to settle in, and some never do.  This may require another operation to re-position them.

The good news is that you can have a quick recovery and immediately “pretty” result if implants are placed above the muscle.

Above-the-muscle breast implant surgery has little to no severe pain.  The implants usually settle in place immediately.  You will feel and look good in a few days.  Of course, you have to heal and swelling takes time to subside.  You should not run or do sports for six weeks, but you can have it done on a Monday and look good in your swimsuit by the weekend.

Why aren’t all breast implants done this way? After all, it’s the natural place for breast tissue. And putting implants under the muscle doesn’t make them look better – the breast shape will always change when you exercise. And the surgery itself is riskier – occasionally the lung is punctured, putting you in hospital with a chest tube!

First, if you are completely flat, the implant will look more natural, less ‘stuck on’, if it is under the muscle. Also if you have a saline implant under the muscle, future mammograms may rupture the implant. (This doesn’t harm you, but the implant has to be replaced.)  Capsular contractures are a bit more common when implants are over the muscle.  But being under the muscle doesn’t prevent these contractures – the risk is still about 1% a year. .

The trend to under-the-muscle implants began in the 1980s, when the old gel implants leaked silicone gel, causing really severe capsular contractures in at least 30% of women.  Plastic surgeons started putting implants under the muscle to reduce these contractures.  Then in the 1990s, the FDA took the old gel implants off the market, compelling plastic surgeons to use only saline implants.  Plastic surgeons started putting implants under the muscle routinely, to avoid the risk that women with little breast tissue, and their partners, would feel or see the implant outline through the skin.

Today, many younger plastic surgeons have never done an over-the-muscle implant, but it is an excellent option.  With the new cohesive gel implants that don’t leak, many surgeons like myself who know how to do over-the-muscle implants, offer this approach to every patient,  except those who are extremely flat-chested.  It makes this operation what it should be – an anatomically natural placement, easy recovery, immediate result.