Placing breast implants under the muscle, known as submuscular placement, is one of the most common locations that plastic surgeons choose. While above the muscle implant location (subglandular) was more commonly done prior to the withdrawal of silicone implants in 1991, saline implants and their risk of rippling and the desire to decrease capsular contracture forced the change to predominantly submuscular placement thereafter. This trend continues today. Now that silicone gel implants are again widely available in the U.S., we may see a shifting back towards more subglandular breast implant placement.
When patients think of ‘under the muscle’ implant placement, they understandably perceive that the entire implant is covered. In reality, only the upper 2/3s of the breast implant is actually covered. The lower 1/3 is only covered by your natural breast tissue which often can be quite thin. Getting the entire implant covered with muscle is possible in two ways. Positioning the implant high so that it is right next to the collarbone (does not make a good breast look) or covering the lower half with fascia. (an option that some plastic surgeons use) Therefore, the best way to think of submuscular position is that it is really ‘partial submuscular’ most of the time.
Knowing that it is only partially under the muscle creates several implant issues that you should know. First and foremost, the bottom of the implant has thinner tissue covering it. This will be an important determinant of your choice between saline or silicone gel implants. This makes it likely that rippling from saline implants will be felt and maybe even be seen over the lower pole of the breast in some patients. If that is a concern then silicone implants may be a better choice. Secondly, more temporary pain will be felt by any form of submuscular implant placement as opposed to above the muscle. While the pain may be more, it will go away quite quickly. Thirdly, recovery from submuscular manipulation is similar to a pulled muscle. How do you recover from a pulled muscle? Use it! There are no physical restrictions after surgery. The more you use it, the faster you will recover. Lastly, submuscular placement results in a fuller upper part of the breast. This is because the thickness of the muscle adds bulk and fullness. This usually creates a more natural but fuller transition from the collar bone down to the nipple over the edge of the upper part of the implant.
Dr. Barry Eppley
Indianapolis, Indiana