Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle.
Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant.
The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture.
The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed.
I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue.
There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.