Getting a breast augmentation can be a very important life changing action that you can do. Most women who do this have better self-esteem and confidence and just feel so much better about the way they look. In addition, clothes tend to fit better, and their bodies tend to have a more hour-glass feminine look that most women desire.


There are many options and decisions to make when deciding on doing a breast augmentation. One of the decisions is whether to place the implants above or below the muscle. The muscle is the pectoralis major muscle, which lies in the upper part of the chest. It starts at the shoulder and fans-out across the chest to the sternum, or the bone in the middle of the chest, in a triangular fashion.


Implants said to be placed above the muscle lie above the p. major muscle, while implants said to be below the muscle are below the p. major muscle. This is important because when above the muscle, the dissection of the pocket, the space where the implant will be inserted, disrupts the breast tissue. On the other hand, placing the implant below the muscle does not disrupt the breast glandular tissue.


Appearance Differences

If the implant is placed above the muscle, the look may be okay for those people who have sufficient fat in that area to cover the implant well. However, if you don’t have much fat in the upper third of your chest, after the implant is placed above the muscle, you may see the round edge of the implant in your upper chest, making the appearance of the implant become quite obvious to others.


This is okay for a few women who want to be obvious that they have implants. And, as long as you have an adequate amount of fat in the upper chest, you may not get that edge look. If that’s the case, placing the implants above the muscle may be a good option. The post-op pain may be less if the implants are placed in the pocket above the muscle since the muscle is not disturbed.


However, the “pasted-on implant” look is not desirable to most women. They would rather have a more natural slope of their chest with minimal to no obvious edge of the round implant visible. Therefore, the best option for them may be to place the implant below the muscle. When performed in this fashion, the upper edge of the implant is covered by the muscle producing a more natural smooth slope of the chest.


Pain after Surgery Differences

Because the muscle must be released from below, the discomfort from the procedure postoperatively may be worse than above the muscle. However, pain meds are prescribed and this is temporary, but the implants are permanent. Thus, most women want the implants below the muscle to give them a less noticeable, more natural look to their breasts.


Capsule Contraction Differences

There are a few other differences between the two options for implant pocket placement. When done above the muscle, there is an increased risk of capsule contraction versus if under the muscle. Here, scar tissue forms that makes the implants appear very hard and firm. If this worsens, the scarring can pull the breast or nipple in the wrong direction and deform the breast, and/or it may make the breasts very painful.


Capsular contraction may be the most important difference between these two methods and can be the most disabling to many women. It causes hardening, for sure, but when it contracts and the nipple goes to one side, that’s a major issue which requires reconstructive surgery to repair it. Treatment for this is to remove the capsule with surgery and place new implants; plus possible repositioning the nipple areola in a preferred position that does entail scars on the breasts. Capsular contraction happens less frequently when the procedure is performed under the muscle.


There are many theories why capsular thickening and hardening with contraction occurs more often when implants are placed under the muscle. The most common theory is that bacteria from the skin travel through the breast milk ducts down to the capsule and cause a chronic infection around the implant. This results in inflammation setting in to fight of the infection with resulting scarring. As the scarring get worse, the thickening of the capsule occurs. Over time, the capsule can them inflame the nerves close to the implants and cause pain, and they can pull on the tissues, otherwise contract the tissues, and distort the appearance of the breast. Whichever the cause, it can be a problem


Movement of the Breast Differences

Another difference is the obvious movement of the breast due to pectoralis muscle movement or contraction. If the implant is under the muscle and the muscle contracts vigorously, the skin many elevate upward, causing an un-wanted appearance. If this happens, you just need to not contract the muscles excessively and you won’t produce this appearance. Alternatively, when placed above the muscle, this problem does not happen.


Breast Feeding, Mammogram and Softness Issues

When implants are above the muscle, the glandular tissue above the muscle has not been modified from surgery as with when implants are above the muscle. This may impact breastfeeding, and it may decrease accuracy of mammograms when above the muscle due to this disruption of the breast tissue when this pocket is used.


Some women don’t want mammograms because they hurt more when implants are placed. If submuscular, the breast tissue is above the muscle and more easily accessible. If a capsular contraction develops, the technician must press even harder, which can rupture the implant. Since capsular contraction occurs more frequently than if submuscular, this may happen more frequently with sub glandular.


In addition, the feel of the breasts may differ. Some say that implants below the muscle are softer since they are covered not only by the fat of the breasts but also by the muscle which is soft when not contracted. Plus, if hardening occurs, the implants definitely don’t feel very soft.



In conclusion, there are differences in the complications and appearance of under versus above the muscle breast implant placements. If a more natural slop is desired with less complications, the best for you may be under the muscle. If you’re considering doing a breast augmentation with implants, come in for a consultation to discuss your options so you get the look and the implants that you want.