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Loftus Plastic Surgery Center

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Under the Muscle vs. Over the Muscle

Dr. Loftus feels that the implant position is on of the most important decisions, and on this page, you will find out why.

Implants can be placed in one of two positions: subglandular, which is between the breast and the pectoralis muscle; or subpectoral, which is between the pectoralis muscle and ribs. Either way, they are centered under the breast.

Terminology for Implant Position

Other Names for Subglandular Other Names for Subpectoral
Under the breast Submuscular
Over the muscle Other Names for Subpectoral
Above the muscle Below the muscle
Between the breast and muscle Between the muscle and ribs

Above the Muscle (Subglandular)

Position of the implant above the pectoralis muscle is known as subglandular placement and offers some advantages. This operation involves less discomfort and faster recovery because the pectoralis muscle itself is not disturbed. Your breasts will immediately appear attractive because swelling is minimal. In athletic muscular women it causes less movement (distortion) of the breast when flexing the pectoralis muscle. Women with ample breast tissue might be more likely to select subglandular placement than women with very modest breasts as larger breasts offer more of a cushion between the implant and the skin, thereby not needing the additional padding conferred by the muscle.

Disadvantages of subglandular position include a higher risk of capsular contracture and greater interference with mammography than subpectoral. Also, women with thin skin, low body fat, or petite breasts are more likely to feel the implants through the skin and are more likely to have rippling and wrinkling. Large implants are more likely to displace downward, and the risks of nipple numbness and infection are slightly higher.

Below the Muscle

Implant position under the muscle, also known as submuscular or subpectoral placement, offers the advantages of a lower rate of capsular contracture, less interference with mammography, lower rate of rippling, and less likelihood of downward displacement. Thin women with petite breasts will obtain their best cosmetic result with the implant placed under the muscle, which provides more padding between the implant and the skin.

Disadvantages include greater postoperative discomfort, greater swelling, and a longer recovery period. After swelling subsides, flexing the pectoralis muscles, such as during exercise, may cause the breasts to move and appear distorted while exercising.

Most women are not deterred by these disadvantages as most of the disadvantages are temporary. As for distortion during exercise, most women find this is a relatively minor disadvantage. Hence, most women (even very athletic women) choose implant placement below the muscle, because the benefits far outweigh the risks.

The "Complete" Submuscular Controversy

Some plastic surgeons tout "complete" submuscular placement, as opposed to subpectoral placement, in which only the upper inner half of the implant is covered by muscle. They claim that the advantage is that the implant is completely covered by muscle, thereby conferring more cushion between the implant and skin along the lower and outer sides of the breast where the pectoralis muscle does not provide coverage. To achieve "complete" submuscular placement, they usually separate the upper portion of the rectus muscle and the anterior portion of the serratus muscle from the ribs. Plastic surgeons who challenge that complete submuscular placement is possible point out that although it is possible to recruit the rectus muscle to cover the lower part of the implant and the serratus muscle to cover the lateral part of the implant, it is not possible to join these muscles together over the implant in most women without distorting the lower half of the breast. Hence, they argue that it is not possible to achieve "complete" submuscular coverage.

Dr. Loftus has found that it is seldom helpful (but very painful) to recruit the serratus muscle for lateral coverage. Whether the rectus muscle can be recruited for coverage of the lower half of the breast is somewhat dependent upon the woman’s anatomy, the size implant selected, and how high or low the implant is optimally placed for aesthetics. so, overall, she strongly advises against "complete" submuscular placement.

Body Builders

Body builders tend to be thin and muscular. As thin women benefit from implant placement under the muscle, and as muscular women have greater muscular distortion with implants placed under the muscle, body builders have found themselves in a quandary.

Implants over the muscle (especially silicone) are more likely to look and feel unnatural because saline will tend to ripple and silicone will have a higher rate of capsular contracture over the muscle. Implants placed under the muscle cause distortion of the breasts when flexing the pectoralis muscles, and this is a problem if and when these women compete in body building shows.

The best solution for these women tends to be Ideal Saline implants over the muscle.

Dr. Loftus by herself

About Dr. Loftus

Dr. Loftus is a female plastic surgeon who is considered a national authority on plastic surgery, having appeared on numerous talk shows as an expert. Her book has become a best-selling book on plastic surgery and has earned her the reputation as a vocal advocate of patient safety, satisfaction, and education in plastic surgery. No wonder her patients have such great things to say about her…
Dr. Loftus and her staff
My results are amazing - Dr. Loftus is amazing!
My friends can't believe how natural I look!
I had no pain after surgery and recovery was so easy.
The entire experience was fabulous!
I am a nurse who has worked with many doctors, Dr. Loftus is the best!
The care was exceptional and results are incredible!
My results are better than I ever imagined!
Dr. Loftus is a rare surgeon: highly skilled, personable and compassionate!
My experience from start to finish was completely extraordinary!
Awesome results from a skilled and caring doctor.
I love love love Dr. Loftus and everyone in the office!
I've never felt so comfortable and understood in a doctor's office.
I felt so comfortable and barely had any pain at all.
I never knew I could look this good! Thank you Dr. Loftus!!!
Never met such a warm and caring staff anywhere else.
If only every doctor could be like Dr. Loftus, how very fortunate we would be.

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TV Appearances of Dr. Loftus

Interview with Local12 WKRC

Dr. Loftus
on Local12 WKRC

Interview with The View

Dr. Loftus
on The View

Interview with The Today Show

Dr. Loftus
on The Today Show

Interview with MSNBC

Dr. Loftus

Interview with Later Today

Dr. Loftus
on Later Today

Interview with Later Today

Dr. Loftus
on Later Today

Interview with CNN

Dr. Loftus
on CNN

Cincinnati: The Christ Hospital2139 Auburn Avenue, Suite 201
Cincinnati, OH 45219
(513) 793-4000
5 minutes from downtown Cincinnati,
At the Christ Medical Office Building

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Northern Kentucky1881 Dixie Highway, Suite 300
Fort Wright, KY 41011
3 minutes from downtown Cincinnati &
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