Breast implants used for breast augmentation can be placed under the pectoral muscle (submuscular breast augmentation) or above the pectoral muscle but below the breast tissue (subglandular breast augmentation).
Going under the muscle means that the muscle overlies the breast implant. This adds an extra layer of tissue over the implant, hiding the breast implant outlines. Also the muscle overlies mostly the upper half of the implant, creating a smoother take-off off the chest, as well as creating a more natural-looking teardrop shape to a round implant (if a round breast implant has been used). Some of the best breast augmentation Plastic Surgeons believe that going under the muscle is the way to for a natural-looking and natural-feeling breast augmentation. Additionally, studies seem to indicate that one of the best ways to minimize the risk of implant capsular contracture is to place a breast implant under the muscle.
Implants placed above the muscle have less tissue masking its outlines, rippling and overall shape. In thin women especially this is a visibly less natural-looking result. In general, most breast augmentation experts use the pinch test to determine whether or not placing a breast implant above the muscle is acceptable. The rule is: if you pinch the skin above the breast, if the pinched skin is >2cm then you can place the implant above the muscle. If the pinch is less than 2cm then the implant will be too visible.
Using anatomical breast implant can be the answer to patients that do not want to place their breast implants under the muscle yet want a natural looking breast.
As the image on above right shows, when the implant sits above the muscle, the implant edge is more visible. Although the image is attempting to illustrate that the implant edge is more visible, in most people it’s not the implant visibility but fullness in the upper half of the breast that is more of an issue. Some women like this. It is the look that a push-up bra will create. If the implant is under the muscle, as the above left diagram illustrates, the muscle overlies the upper half of the implant and thus creates a smoother take off from the chest wall. This is a more natural shape for a breast.
In conclusion, a submuscular placement of a breast implant will give you a more natural-looking breast augmentation. Using anatomical implants is an option if you prefer not to go under the muscle. A round implant over the muscle will result in a bubbly push-up bra look.