Female breast surgery

Should breast implants be positioned over or under the muscle?

Breast implants are a traditional option for women who wish to improve the aspect and/or volume of their breasts. But before taking the plunge, many women ask what is the best positioning of the breast implant: over the pectoral muscle, under the muscle… or a bit of both?

I would like to tell you a little more about the benefits and drawbacks of each of these options and the different techniques. In any case, it is during the consultation that we will determine the best approach together.


Implant positioning: an important criterion

The positioning of the breast implants is an important criterion, as it can have a considerable impact on the aspect, feel, and durability of the results of the breast surgery over time. Each option has its benefits and drawbacks.

The choice of implant position depends on:

  • The quantity of breast tissue (fat and gland)
  • The desired shape and size of the breasts
  • The quality of your skin
  • Your level of physical activity (if you are very or not so sporty)
  • Your age, your body shape…


Some specific examples:

  • A woman who has little breast tissue (significant breast aplasia or hypotrophy) and would like larger breasts can have the implants placed under the pectoral muscle, and even more so if she has a slim even thin thorax. This approach helps to hide the implant and give the chest a more natural appearance.


  • For a patient with enough breast tissue and toned skin (naturally developed, well-supported breasts but wishes to increase the volume) desiring a more moderate breast augmentation, positioning over the pectoral muscle, just under the gland, can be considered.


Under or over the muscle: understand the differences better


Firstly, it is essential to understand the anatomy of the breasts: on the chest, the rib cage is covered with muscles (pectoralis major and minor, and insertion of the abdominal muscles). Over the muscles is the mammary gland, which is covered with skin. The physiological (natural) position of the breast is therefore over the muscles.

When an implant is placed over the pectoral muscle, it is inserted directly under the mammary gland.

When it is placed under the muscle, the implant is inserted under the pectoral muscle, which means that the implant is totally covered by the muscle.


What are the benefits and drawbacks of each technique?


Benefits of implants inserted over the muscle

This is the physiological position and allows natural movement of the breast. Contrary to popular belief, this position does not necessarily hurt less than the submuscular position.


Drawbacks of implants inserted over the muscle

  • Implants placed over the muscle can be more visible, particularly in women with a thin or slim thorax and little breast tissue. This can result in an artificial appearance of the breasts and be more difficult to correct if the results are not satisfactory.
  • If the skin is thin, fragile, and tends to sag, the weight of the implant will stretch the skin leading to greater breast ptosis (sagging).


Benefits of inserting an implant under the pectoral muscle

  • As the pectoral muscle covers the implant, it can make the results more natural and also last longer (the implant is protected more).
  • This position can help hide the implant and is an advantage for slim patients.


Drawbacks of the submuscular position

  • Positioning under the pectoral muscle requires the muscle to be detached, which can be an issue for very sporty patients using their arms a lot.
  • The appearance sometimes becomes less natural with time: the implant remains firmly wedged under the muscle, whereas the gland sags.


Dual Plane technique: the innovative breast augmentation method


Now there is a hybrid technique known as the Dual Plane technique (two planes): the upper part of the implant is placed under the muscle (the muscle partially covers the implant), while the lower part is placed under the gland.

The Dual Plane technique is preferred whenever possible: it reduces the risks of complications by taking the benefits of each.

It is generally recommended for women with a moderate amount of breast tissue who are looking to increase the volume while maintaining a very natural appearance.

It also has the advantage of aging well, even if the mammary gland drops.


In summary: which technique?

Ultimately, the choice of breast implant placement technique depends on several factors:

  • Your skin
  • Your anatomy
  • Your natural breasts (development of the gland, fat)
  • The desired result: shape, size
  • Your age
  • Your lifestyle
  • Your level of physical activity

During the consultation, I will examine the quality and quantity of existing breast tissue, the shape of your breasts, and the position of the areolas and the nipples to determine the most suitable placement technique. Whatever the position of the implant, the different incisions – areolar or inframammary – are still possible and we will also look at that together.

Together we will discuss the benefits and drawbacks of each option to choose the most suitable method for your needs, your personality, and your constraints.

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