Breast Implant Position Part I

A Blog on Deciding Whether to Place Implants Above or Below the Muscle by Dr. Loftus

Women considering breast augmentation frequently ask, "Should I have my implants placed over or under the muscle?" Answering this question is easier than you might think, once you have the right knowledge. Although this blog will probably give you a good idea what the right choice is for you, the best way to make that decision is during your consultation. After considering your goals and performing an examination, we can help you discover what implant position will work best for you in the long term. First, it is important to understand how your breasts get their final shape from a breast augmentation. Then, you will be able to better understand the advantages and disadvantages of various implant positions.

Implant vs. Breast: The Battle for Your Final Breast Shape

Before we discuss implant position, it is important to understand how you arrive at your final breast shape after an augmentation. Your breasts have a certain shape to them. An implant has a certain shape. They both have variable stretchy characteristics. They both have variable degrees of softness.

Breast Skin Elasticity

Your breasts are covered with skin that has elasticity. Usually your skin gets less elastic as time (and pregnancies) go by. The amount of skin and elastic quality of that skin, the amount of breast tissue inside the skin and the distribution of that breast tissue all add up to determine your breast shape. More skin, less elasticity and less breast tissue filling results in a breast that looks deflated and ptotic (saggy). More breast tissue and less, tighter skin result in a perkier breast.

Breast Implant Effects on Breast Shape

The implant is designed to have a particular shape, volume, and projection. Implants have different levels of softness and change differently with compression, depending on what they are filled with. (See Breast Blogs Saline vs. Silicone I, II, and III) There are all sorts of implants that vary in these characteristics. Implants can have the same volume, but the degree of projection can vary and result in different shaped breasts. The degree of projection is often referred to as "profile" (for example: High profile, moderate profile, etc.)

Breast Interacts with Implant

So, now we have your breasts on one side, and the implants on the other. In the operating room we bring them together and they interact. The breast pushes on the implant, and the implant pushes on the breast. All of these characteristics we have discussed intermingle to give your final, unique shape. The shape that results is not solely determined by the implant or the breast, but somewhere in between. Perhaps this sounds like complete chaos. Rest assured. With training and experience a plastic surgeon knows how to predictably combine these factors to get the result you want. That’s why we ask about your goals during your consultation, so we can help you make the right decisions. Now that you understand the interaction between implant and breast, we can discuss how different implant positions affect shape and a few other things. In the next blog, we will discuss placing the implant over the muscle.