Breast augmentation remains one of the most popular cosmetic procedures in the United States. While many patients focus on implant size and type, breast implant placement is one of the most important decisions that affects the final look, feel, and long-term results of the surgery.
In this article, we explore the fundamentals of breast augmentation, the different breast implant placement options, and how implant types influence the best placement choice. Dr. Joseph Kelling, a board-certified plastic surgeon in Dallas, Texas, shares valuable insights on the pros, cons, and ideal candidates for each technique.
Breast augmentation is a surgical procedure designed to enhance the size, shape, and symmetry of the breasts using breast implants. It can restore lost volume after pregnancy or weight loss, improve body proportions, and boost self-confidence.
While the choice of implant size and material is important, breast implant placement — whether the implant is positioned above or below the pectoral muscle — plays a critical role in the final aesthetic outcome and potential complications.
There are three primary breast implant placement options:
Over the muscle breast implants place the implant directly behind the breast gland and in front of the pectoralis muscle. This was the original technique used in the early decades of breast augmentation.
Under the muscle breast implants position the implant partially or completely beneath the chest muscle. Dual plane breast implants combine both approaches — the upper portion of the implant sits under the muscle while the lower portion sits under the breast gland.
Dr. Kelling notes that while early subglandular breast augmentation had higher complication rates, newer implant technology has made over the muscle placement more viable again for carefully selected patients.
Implant type significantly influences the best breast implant placement choice.
Traditional saline and older silicone implants tended to show more rippling and had higher rates of capsular contracture when placed over the muscle. This led to the widespread adoption of under the muscle breast implants and dual plane breast implants, which provided better coverage and lower complication rates.
However, newer breast implant technology has introduced implants specifically engineered for over the muscle placement. These modern implants feature improved shells designed to reduce capsular contracture and significantly less rippling.
Dr. Kelling explains: “The new implants that are available tend to ripple much less, so if the patient has an adequate amount of soft tissue thickness or breast gland, you can still hide that breast implant well on top of the muscle, and you're not seeing the same amount of rippling that you were seeing with the older breast implants.”
He adds that some newer implants have “a special shell that is really designed to decrease the rates of capsular contracture.”
Because of these advancements, over the muscle breast implants are now a realistic option for patients with sufficient natural breast tissue to camouflage the implant.
Advantages:
Disadvantages:
Dr. Kelling states that he still performs a dual plane surgery the majority of the time because “we have better long-term data with that operation, and you also have the added support of that muscle helping maintain the position of the implant over a long term.”
The dual plane has the added benefit of having the lower pole of the breast implant sitting under the breast glans where you have the most soft tissue coverage and desired volume.
Advantages:
Disadvantages:
Dr. Kelling emphasizes that breast implant placement should be highly individualized: “It largely comes down to patient selection.”
He recommends over the muscle placement for:
He continues to favor under the muscle or dual plane for most patients due to proven long-term safety and support: “Putting the implant half under the muscle or in a dual plane position really took care of a lot of the complications that we saw with implants that were placed over the top of the muscle.”
Every patient is different, and there is no universal “best” breast implant placement. Factors such as body type, existing breast tissue, lifestyle, chest wall shape, and aesthetic goals all play important roles.
Dr. Kelling advises: “Patients having some understanding and having some knowledge of each one of the operations helps us guide the discussion and narrow it down to really decide [whether] above the muscle or below the muscle the better operation.”
During your consultation, Dr. Kelling will evaluate your anatomy and help determine whether over the muscle, under the muscle, or dual plane breast implants will give you the most natural and satisfying long-term result.
Breast augmentation offers beautiful, life-enhancing results when the right implant and proper breast implant placement are chosen. Thanks to advances in implant design, patients now have more viable options than ever before — from traditional under the muscle breast implants to modern over the muscle techniques.
Understanding the differences between submuscular, subglandular, and dual plane breast implants empowers you to have a more informed conversation with your surgeon.
If you’re considering breast augmentation, schedule a consultation with Dr. Kelling today to discuss which breast implant placement option is best suited for your body and goals.
