Implants Under the Muscle and Capsular Contracture
While most patients who come for a breast augmentation consult realize that most surgeons place breast implants underneath the pectoralis (chest wall) muscle, often they aren’t aware of why that is. Originally (back in the 1970’s and 1980’s) implants were routinely placed above the muscle. This was felt to be the most physiologic location. And in most cases, it worked well.
Lower Rate of Capsular Contracture
However, soon it was determined that placing the implants below the muscle resulted in a much lower incidence of capsular contracture (hardening of the implant). Capsular contracture is a problem which usually requires more surgery to correct. Sub-muscular implants also often result in a more natural look, making the implant less susceptible to being palpable.
No Free Lunch – Negative Associations
Of course, there is no “free lunch”. Sub-muscular breast augmentation does have some negatives associated with it. When patients with sub-muscular implants flex their muscles (during a push-up or bench press) the breast will move or bounce to some extent. I usually inform patients of this fact, but concede that it is normally only a significant issue for women who frequent gyms regularly, are body builders, or make their living swinging around a pole.
We recommend the Ideal Implant for patients as it was backed with an 8 year study to show lowest incidence of capsular contracture and rupture rates.
Only In the Case of a Surgical Revision
In short, the only time I will place an implant above the muscle is when I need to do this in some type of surgical revision from another surgeon. Otherwise, it’s always sub-muscular implants.