A Patient Guide to Breast Augmentation
Lesson FIVE:
Implant Pocket
Implant placement:
over vs. under the muscle.
Once your look and implant are chosen, one more decision shapes both the result and your recovery: where the implant sits relative to your chest muscle. Here are the options, and how we decide together.
Placement
Your placement options
There are two main positions, plus a common hybrid. None is “best” for everyone — the right choice depends on how much natural tissue you have, your goals, and how active you are.
Over the muscle
Subglandular
implant above the muscle, under the breast tissue
The implant sits on top of the pectoralis muscle and directly beneath your breast tissue. This tends to suit patients who already have enough natural tissue to cover and soften the implant, and it avoids any movement of the implant when the chest muscle flexes.
Advantages
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+Quicker, more comfortable recovery
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+No movement of the implant when you flex
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+Can lift and fill a slightly sagging breast
Trade-offs
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−Edges/rippling can show more in thin patients
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−Less soft-tissue cover over the top
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−May slightly complicate mammogram imaging
Under the muscle
Submuscular / Dual-plane
upper part of the implant sits beneath the pectoralis muscle
The most common approach. Usually done as a dual-plane — the top of the implant tucks under the chest muscle while the lower part sits under the gland — which adds extra soft-tissue coverage over the upper pole for a smooth, natural transition. Often preferred for patients with less of their own tissue.
Advantages
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+More coverage → smoother upper pole, less rippling
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+May lower the risk of capsular contracture
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+Generally better for mammogram imaging
Trade-offs
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−Recovery is a bit longer and more sore
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−Flexing can temporarily move the implant (“animation”)
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−Can matter for heavy weightlifters/athletes, wo are higher risk for movement of the implant with activity
A Variation
Subfascial
under the thin fascia that covers the muscle
A middle-ground option in which the implant sits above the muscle but beneath the fascia — the thin sheet of connective tissue over it. The fascia adds a little extra support and coverage compared with sitting purely under the gland. We use it selectively, and we'll tell you if it's a good fit for your anatomy and goals.
Advantages
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+No significant movement of the implant when you flex
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+Quicker, more comfortable recovery than under the muscle
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+A little more coverage and support than purely over the muscle/subglandular approach
Trade-offs
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−Still less upper-pole coverage than under the muscle
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−Edges/rippling can show in very thin patients
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−Needs enough of your own tissue; not ideal if very thin
My approach — how I choose
In most patients, my personal preference is the subfascial plane. It gives the most natural settling and shape — because the implant sits above the muscle, the pectoralis can't push it down and out the way a strong chest muscle can when the implant is placed beneath it. It also has the least chance of animation (the implant moving when you flex). For any patient with enough of their own tissue to cover the implant, subfascial is my preference.
That said, I don't hesitate to use a dual-plane when it's the better fit — usually for patients with thinner tissue, who benefit from muscle coverage over the upper part of the implant. It's an excellent option in its own right, and I create very nice, natural results with it routinely.
Why not full submuscular? Placing the implant completely under the muscle doesn't add meaningful coverage over a dual-plane — dual-plane already puts muscle exactly where it's needed, over the upper implant — and implants tend to settle more naturally with a dual-plane than fully under the muscle.
Subglandular is my least favorite. Compared with the others it carries a higher chance of rippling and of capsular contracture — scar tissue tightening around the implant and changing its shape — so I use it very minimally in my practice.
At your consultation I'll assess your tissue and goals and recommend the plan that fits you.
Next Lesson
Keep it going
Explore More Breast Augmentation topics
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How projection and width change the same volume's shape on your frame.
"Gummy bear" and beyond — how firm vs. soft gels feel and hold shape.
Search through before and after images organized by Category of what general "look" each patient has
To schedule an appointment to discuss achieving your breast goals, please click here to contact us, click the below link to schedule online, or call us at (469) 899-8758.
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