Breast Implant Placement: Over Muscle Vs Under

When deciding on exactly how you would like your breast implants to look, one of the key things you will have to decide is whether to have the implant placed ‘over’, or in front of the muscle, or ‘under’, or behind the muscle. The choice between overs and unders is primarily a personal preference, though factors such as your body shape and breast tissue can mean that one may look more natural than the other. Here, we will explain the differences between overs and unders, why some clients opt for one over the other, and which option may suit different body types.

Under the Muscle Implants

The muscle that we are talking about is the pectoral muscle, which covers the front of the ribcage. If you opt to have your breast implants fitted underneath this muscle, this is known as a ‘sub-muscular placement’. During the procedure, the surgeon will create the ‘pocket’ between the muscle and your ribs, and this is where your implant will be inserted.

Sub-muscular placement is often advised for women who have little amounts of breast tissue to begin with. This is because implants placed over the muscle can look too obvious as there is not enough natural ‘padding’ – under-the-muscle implants, on the other hand, can look more natural because the muscle itself covers the implant.

Advantages of Under-the-Muscle Implants

• As stated, under-the-muscle implants can look more natural because the outer edges of the implant cannot be seen.
• Visible ‘rippling’ is less likely with unders because both breast tissue and muscle sit in front of it.
• Unders cause less pressure on the skin of the breast because the muscle takes a lot of this pressure. Skin is therefore less likely to look as ‘worn’ and stretched as it would if it had an implant directly beneath it.
• The chances of an implant ‘bottoming out’ is less likely with unders.
• Similarly, there is thought to be less chance of capsular contracture.
• Unders lead to clearer mammograms because there is nothing blocking the breast tissue.
• Blood flow to the nipple is also better with unders, which can be especially good for those who may have to consider further surgery or breast lifts in the future.

Disadvantages of Under-the Muscle Implants

• Some people regard placing an implant uder the muscle as being a more invasive procedure.
  Recovery time can be longer with unders.
• There may be some restrictions as to how big a patient can go with implants that sit under the muscle, depending on the body size of the patient.
• The muscle can take around 4-6 weeks to relax after the surgery, and until that point the breasts may seem to sit a little higher than you would like.
• Depending on the exercise that you do, flexing your chest muscles may make unders seem distorted.

Over-the-Muscle Implants
Overs are placed in front of the pectoral muscles, and so sit between the breast tissue and the chest muscle. This is known as ‘subglandular placement’ of implant. The effect that subglandular placement has on the overall look of the breasts very much depends on how much breast tissue you have to begin with. As you can imagine, women with very little breast tissue – meaning those with smaller breasts to begin with – do not have much for the implant to sit behind. This is why in some cases, overs can look as if they sit very close to the skin and the outline of the implant can be more obvious. Overs tend to leave the patient with a more obviously augmented look, which is why some women choose to go for the option underneath the muscle. However, if you prefer the rounded, enhanced look, then you may actually prefer this effect that can be created by overs.

Also, overs can still look very natural on women with more breast tissue to begin with. As a general guide, if you are a large B cup or bigger prior to surgery, then there can still be enough padding in front of the implant for the edges not to look too obvious.

Advantages of Over-the-Muscle Implants

• Because the muscle has not been altered with, there is often less discomfort after the operation with overs, and recovery time is thought to be lessened.
• The procedure itself is somewhat more straightforward and less invasive than sub-muscular placement.
• Overs can be placed closer together than unders can, which is useful it you want to create more of a cleavage.
• There is also the potential to have larger implants with overs, as they do not depend on being able to fit underneath the natural muscle.
• Overs do not become affected or distorted if the chest muscle is flexed duing exericse.

Disadvantages of Over-the-Muscle Implants

• If there is not much breast tissue, then a lot of strain can be put on the skin, which can result in stretch marks.
• If there is less tissue between the skin and the implants, then there is a higher chance of visible rippling. This can particularly be a problem with saline implants, which tend to be less moveable than silicone.
• With less support of the implant, the risk of ‘bottoming out’ is somewhat higher in overs.
  Overs can get in the way of effective mammogram screenings, meaning it is likely to have to repeat tests.

Are Overs or Unders Better for Breastfeeding?
Many women think about the likelihood of their implant position affecting their chances of being able to breastfeed. A common misconception is that women with over-the-muscle implants won’t be able to breastfeed; however, this is not usually the case. Even overs are still inserted beneath the glands, meaning that most women with implants will still be able to deliver milk to their babies as normal.

Because of the positioning of the implant, there is a slighter higher risk of the ducts or glands becoming damaged during the surgery when fitting overs, and so some women may choose to have implants fitted underneath the muscle just to lessen this risk. However, many women have overs inserted without any damage and so can breastfeed.

Ultimately, although things such as your natural breast tissue can have an impact on how different overs and unders may look, the choice is down to you. Your surgeon can advise you on how each type of implant would look on your body and what, if any, side effects you should expect from your decision. As part of your researching prior to your procedure, you should take a look at photographs of women with both under-the-muscle and over-the-muscle implants to see which look you prefer (and whether you can notice the difference).