Below Muscle

Below Muscle Implants are the Most popular, But Not Best for Everyone

Breast implants may be placed above or below the (pectoralis) muscle. Although about 90% American surgeons routinely insert the implant below the muscle, we recommend above muscle implants for most (but not all)patients. In any case, placement will be a patient choice.

Case 1: This patient had 330 cc saline implants placed above the muscle via an umbilical incision. There are no scars around the breast.

Compare the above muscle implants of case 1, to the below muscle implants of cases 2 below.

Below muscle implants are less expensive, but don’t look as natural as above muscle implants because they ride higher and have the shape of the (pectoralis) muscle, not the breast.

The nipple incision may be well camouflaged.

Case 2. This patient had 330 cc implants placed below the muscle via an areolar incision. Notice that a below muscle implant is compressed and elevated by the muscle above. With time, the pectoralis muscle will fatigue, and the breasts will have more projection. As the muscles fatigue, the below muscle implants will drop. The muscle can be trained to fatigue with a strap, so that the implant can be made to come down as much as is necessary-after about 6-9 months.

Below muscle implants, like in case 2, give the maximum lift and can provide an athletic look, favored by some women.

The below muscle saline implant, using the areolar (nipple incision) is the least expensive breast augmentation procedure.

Notice that the areolar (nipple incision) is very cosmetic when done properly.

However, many women favor a more feminine look, and choose above muscle implants.

It is important to remember that the normal breast is located above the (pectoralis) muscle. Therefore, above muscle implants are more natural than below muscle implants.

More importantly, below muscle implants are constantly being squeezed by the muscle whenever the (pectoralis) muscle contracts. This happens when the shoulder bears down with resistance. When below muscle implants move,they usually move either towards the neck or towards the armpits. Eventually, this constant muscle contraction may cause migration of the implants towards the armpits. Implant migration causes an apparent loss of volume. In my experience, below muscle implants are more likely to cause inflammation and pain of the pectoralis muscle because the muscle has to move around the implant every time the shoulder is moved.

The only advantage of below muscle implants is less rippling. Rippling is mainly a problem with above muscle saline implants that are placed in women with very small (A cup) breasts. In these women, there is very little breast tissue to cover the implant, and a below muscle implant may be a better option. Women with small breasts (A cup) who desire saline implants may have less rippling with below muscle saline implants. Women with larger breasts (B cup or higher) look better with above muscle implants.

Generally, below muscle placement causes significant more pain and longer recovery times (1-2 weeks) than above muscle implants. Return to physical activity is much slower with below muscle implants (6 weeks) than above muscle implants (6 days).