UNDERSTANDING THE TYPES OF BREAST IMPLANT PLACEMENT
When people compare over vs under muscle breast implants, they are really comparing where the implant sits in relation to the pectoralis major, the large chest muscle that lies behind the breast. The implant itself can be identical in both cases. What changes is the layer of tissue covering it, and that layer shapes how the result looks, feels, and ages.
There are two main types of breast implant placement:
- Over the muscle (subglandular): the implant sits behind the breast tissue and in front of the chest muscle
- Under the muscle (submuscular): the implant sits partly or fully behind the chest muscle
Most under the muscle procedures today use a dual plane approach. The upper part of the implant sits beneath the muscle, while the lower part sits beneath the breast tissue. This gives extra coverage at the top of the breast, where implant edges are most likely to show, while letting the lower pole of the breast fill out naturally.
Some surgeons also use a subfascial technique, which places the implant under the thin fascia layer that covers the muscle rather than under the muscle itself. It is usually discussed as a variation of over the muscle placement, and whether it suits you is a question for your consultation.
OVER THE MUSCLE BREAST IMPLANTS: PROS AND CONS
Over the muscle breast implants sit directly beneath your natural breast tissue. Because the chest muscle is left undisturbed, this placement is often associated with a gentler early recovery.
Potential advantages:
- Less discomfort in the first days after surgery for many patients, because the muscle is not lifted
- No movement or distortion of the implant when you flex your chest muscles
- A slightly lifted look in some patients with mild sagging, since the implant fills the breast tissue directly
- Can suit patients who already have a good amount of natural breast tissue
Potential drawbacks:
- Less coverage over the implant, so edges and rippling can be easier to see or feel, especially in slim patients
- Some studies associate this placement with a higher risk of capsular contracture, the firm scar tissue that can form around an implant
- A rounder, more defined upper slope that may look less natural on patients with very little tissue
Over the muscle placement is often a good fit when there is enough natural tissue to cushion the implant. Women who do a lot of upper body strength training sometimes prefer it because the implant does not move when they contract their chest muscles.
UNDER THE MUSCLE BREAST IMPLANTS: PROS AND CONS
Under the muscle breast implants use the chest muscle as an extra layer of coverage over the top of the implant. For many patients, especially those with a slim build or minimal breast tissue, that added layer is the main reason surgeons recommend it.
Potential advantages:
- More soft tissue over the upper implant, which can help hide edges and rippling
- A smoother, more gradual slope from the collarbone to the nipple that many patients find natural
- Many surgeons and studies associate this placement with a lower rate of capsular contracture
- The muscle layer may make it easier to image breast tissue during mammograms
Potential drawbacks:
- More discomfort in the first week or two, because the muscle is lifted and stretched
- Implants can take longer to settle into their final position
- Animation deformity, where the implant shifts or distorts when the chest muscle flexes, is possible
When patients weigh under the muscle breast implants vs over, they are usually trading a slightly easier recovery for more coverage and a softer upper slope. Recovery for both placements usually allows a return to your regular schedule within about 5 to 10 days, though under the muscle placement can feel tighter for longer. For a closer look at the healing process, see the complete guide to breast augmentation recovery week by week.
HOW IMPLANT TYPE AFFECTS PLACEMENT
Placement and implant choice work together. Alberta Plastic Surgery offers both saline and silicone implants, and the two types of breast implants behave differently under the skin.
- Saline implants are filled with sterile salt water. They tend to feel firmer and are more prone to visible rippling, so many surgeons prefer to place them under the muscle for extra coverage.
- Silicone implants are filled with a cohesive gel that many patients feel is closer to natural breast tissue. Because they ripple less, they can work in either placement, depending on how much natural tissue you have.
That is why the saline vs silicone implants decision should not be made in isolation. A saline implant over the muscle on a slim frame may show more rippling than the same implant under the muscle, while a silicone implant over the muscle can look very natural on a patient with enough tissue. If you are still comparing fills, our post on silicone vs saline breast implants covers the differences in more detail.
CHOOSING THE RIGHT PLACEMENT FOR YOUR BODY
There is no single best placement. The right choice comes from an honest look at your anatomy and goals, which is why Dr. Ladak makes the placement decision during your pre-surgical consultation rather than in advance.
Factors that usually guide the decision:
- How much natural breast tissue you have, and how thick the tissue is at the top of the breast
- Whether you prefer saline or silicone implants
- The implant size and profile you are considering
- Any existing sagging, which may mean a lift should be part of the conversation
- Your activity level, particularly strength training that works the chest
- Your comfort with a longer early recovery in exchange for more coverage
Questions worth asking at your consultation:
- Which placement do you recommend for my body, and why?
- How visible could rippling or implant edges be with each option?
- How will each placement change my recovery and return to exercise?
- How might my results look in 10 years with each placement?
If you have noticeable sagging, an implant alone may not give the result you want in either position. In those cases, a breast augmentation mastopexy, which combines implants with a lift, may be worth discussing.
At Alberta Plastic Surgery, Dr. Adil Ladak, a board-certified plastic surgeon trained at the University of Alberta with fellowships at the Mayo Clinic and the University of British Columbia, helps patients across Edmonton and Alberta choose the implant type, size, and placement that suit their bodies. If you are considering breast augmentation in Alberta, a consultation is the best place to compare over and under the muscle options for your specific anatomy.
FAQs
Q: Is over or under the muscle placement better for breast implants?
A: Neither is better for everyone. Under the muscle placement gives more coverage and can hide implant edges in slim patients, while over the muscle placement often means an easier early recovery and no implant movement when the chest flexes. Your surgeon will recommend a placement based on your tissue, implant choice, and goals.
Q: How much do breast implants cost in Edmonton?
The cost of breast implants in Edmonton depends on the implant type, surgical technique, anesthesia, facility fees, and whether a lift is combined with the augmentation. Because every plan is personalized, Alberta Plastic Surgery confirms pricing after your consultation. Financing through Medicard is available for patients who prefer to pay in monthly instalments.
Q: Does implant placement affect mammograms?
A: Implants in either position can make some breast tissue harder to see on a mammogram. Under the muscle placement is often thought to interfere less with imaging. Whatever placement you choose, always tell the imaging technician you have implants so they can take the additional views needed for a complete screening.
