In breast augmentation surgery, implants are placed either in a “pocket” formed behind (subpectoral/submuscular) or directly in front (prepectoral/submammary) of the large chest wall muscle known as the pectoralis major muscle. While both of these locations can provide nice results, positioning breast implants behind the muscle generally provides superior, more natural-looking outcomes including long term.
In the submammary position, the overlying skin typically stretches and thins out over time due to the weight of breast implants, with larger implants having a greater negative impact. This can lead to problems such as contour irregularities, greater palpability of the implant (ability to feel the actual implant) and a greater chance of noticeable rippling on the skin. Additionally, implants placed in front of the pectoral muscle often create the extremely round, fake-looking, “bolted on” appearance that most women wish to avoid.
In contrast, the subpectoral position provides better short- and long-term support for the implant, increased tissue coverage overlying it which provides a more natural feel and appearance, and a smoother, more gradual interface between the implant and chest wall. As a result, the breasts tend to both look and feel more natural. Additional benefits of submuscular implant placement include a reduced risk of capsular contracture, a diminished risk of visible rippling of the overlying skin and improved accuracy in the interpretation of mammograms.
Ultimately, specific implant placement will depend on each individual’s unique needs and goals. However, and because of the reasons enumerated above, I strongly advocate placing implants behind the pectoralis major muscle and do so for virtually all of my patients.
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