Birmingham Breast Augmentation - Balancing risk for Implants over or under the muscle

One of the questions we get asked the most during consultations for breast augmentation is whether an implant should go over or under the chest (pectoralis major) muscle. There are wide variations in surgeon and patient preferance when you survery the world on this. In general, the American surgeon is much more likely to suggest an under the muscle placement as opposed to our colleagues in Europe, South America, or Asia.

Why the difference? It's a question of risk versus benefits.

The controversy over silicone implants in the United States in the 1980's led to a rapid conversion to saline filled implants. Saline implants perform poorly under thin tissue in terms of visability and wrinkling. To compensate for this, a bias for sub muscular placments emerged to conceal the devices more. There may or may not be some advantage in terms of less hardening of the implants over time, another purported benefit.

What's the downside of submuscular placement

• more pain post-operatively
• potential "animation" of the devies with movement or exercise
• gradual drift of the implant down and lateral from the contraction of the muscle
• sliding of the breast tissue down over the muscle with age producing the "Snoopy deformity"

When suggesting the proper implant position for a patient, the most important consideration is how thick the breast tissue coverage in the upper breast is. If  a pinch of the tissue suggest 2cm+ thickness, most people have enough tissue to consider either subglandular (over the muscle) or subfascial placement (over the muscle but under the muscle fascia). Other factor we assess are skin quality (thick or thin), amount of ptosis (droop), and how physically active the patient is.

If you're a prospective patient for this type of surgery and would like to come in for a consultation, please feel free to call us at (205) 298-8660.

Cheers!

Dr. Rob Oliver Jr.