After deciding which type and size of breast implant is right, the next most challenging decision breast augmentation patients need to make is about breast implant placement. Traditionally there have been two choices: placement under the glands or under the muscle. Now a third choice is emerging, one that’s both intriguing and controversial—subfascial placement.
Picture your breasts from a side view. In a subglandular placement, implants are located closest to the skin, under the fat and milk ducts that make up breast tissue. In a submuscular placement, the implants are positioned either partially or fully under the pectoral (chest) muscles, more deeply under the surface of the skin. That’s why many patients use the shorthand “overs” and “unders” terms to describe these two options.
Subfascial placement puts implants right in the middle of these two options. Muscle fascia, a thin sheet of connective tissue, covers and protects the pectoralis muscles just as it does many other muscles in the body. Some surgeons are promoting subfascial breast implant placement as a possibility for some patients as a way to potentially ease some of the drawbacks of the two tried and true placement options.
Placing breast implants in the subglandular position is fairly straightforward surgery. No muscles are cut, therefore recovery tends to be easier. But since less tissue covers the implants, there is a greater risk the devices will be noticeable, either because they project more abruptly from the chest wall and/or because implant edges and ripples may be visible. This is particularly true of women who are petite and have little body fat.
Submuscular implant placement is favored by many plastic surgeons as it creates a more natural look via a gradually-sloping chest wall. (Additionally, some believe there is less risk of capsular contracture, or shrinking and hardening of the breast pocket, with below the muscle placement.)
With these choices in mind, it may seem like a plastic surgeon and patient would be able to select the right implant placement for just about any given situation.