Positioning and placement of breast implants

There are essentially two basic breast implant positions when considering breast augmentation plastic surgery. The complexity of these two breast implant positions is in how much of an understanding a woman has of human anatomy and the terms used to describe subtle differences in these two basic breast implant positions.

The two breast implant positions used for augmentation are best defined in relationship to either the breast gland or the underlying chest muscle, or most commonly a blend of the two. A breast implant is placed either above the chest wall muscle (pectoralis muscle) or below the muscle. If the breast implant is above the muscle, it is called ‘above the muscle’, or ‘above the pectoral muscle’. Another term that may be used to describe this exact position is in relationship to the breast gland. A breast implant placed ‘above the muscle’ is also called ‘below the breast gland’, ‘below the gland’ or the ‘subglandular’ breast implant position. ‘Sub’ means below.

Right implant above muscle, left below

Right implant above muscle, left below

This image demonstrates above the muscle and below the muscle without the gland being present. The second and more popular primary breast implant position is called ‘below the muscle’ or ‘below the pectoral muscle’, or ‘subpectoral’ breast implant position. Again, ‘sub’ means below. The good thing about using the muscle as the main defining point is that an implant is then simply either ‘above’ or ‘below’ the muscle. If the below prefix ‘sub’ is used, then a breast implant is either ‘subglandular’ or ‘submuscular’ to describe these two major breast implant positions.

cross section of breast and implant

cross section of breast and implant below muscle

Women can often be confused when subtle differences in subpectoral breast implant positioning is added to the verbage of the overall breast implant position. Terms like ‘partial submuscular’, or ‘partial subpectoral’ are used to more accurately describe the breast implant position. In general and simplistic terms there are two main positions to remember, above or below the muscle.

The more specific terms describing the submuscular breast implant position vary by every plastic surgeon. Partial submuscular breast implants means that the chest wall muscle was released from the chest wall to insert the breast implant and to improve the aesthetic breast result. Technically speaking, nearly all breast implants are ‘partial submuscular’. Whether any of the muscle or the degree of muscle release is determined by the plastic surgeon and will vary for every woman. When no muscle is released, the breast implant will usually remain high on the chest and not fall as much as a slightly released chest muscle during breast augmentation. Complete muscle coverage may sound best but in reality it is not nearly as predictable or suitable for most women.

When the pectoral muscle is released to position the breast implant, the breast implant will settle at the lowest point of the breast. The lowest point of the breast is usually at the inframammary fold. At the inframammary fold, the breast implant will be covered only by the breast gland and skin. So what actually has happened is that the upper part of the breast implant is below the muscle and the lower edge of the implant is below the gland. This is why it is sometimes called ‘partially subpectoral’.

Breast implants placed above the muscle are only below the gland. So if a woman does not have a lot of natural breast tissue or poor skin quality, the breast implant may become visible over time and will be able to be felt much easier than the other breast implants position (subpectoral). The breast implants position is more often used only if a woman has the correct breast chartacteristics like good skin, and plently of breast gland to hide the implants.

Breast implants placed below the muscle provide an extra layer of tissue coverage and makes it less likely to be seen. Breast implants placed below the muscle can still be felt over time. The breast implants are usually felt along the outer side of the breasts and occasionally along the bottom or inframammary fold. Breast implants below the muscle usually will provide a better, longer lasting result with less skin stretch than the above the muscle position.

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