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'In Front' of or 'Behind' the Muscle

"Is it better to place the implant behind or in-front of the chest muscle?"

The main muscle of the front portion of the chest is called the Pectoralis Major. The breast sits directly on top of this muscle. A breast implant can be placed in front of the Pectoralis Major muscle, behind breast tissue alone, or it can be placed behind both the breast and the muscle. The basic goal of all breast augmentation is to have a naturally appearing enlarged breast. The general rule is that the more of the patients own tissue that is available to cover the implant, the better, as this will give a more natural appearance. Therefore, the decision is often based on how much breast tissue the patient is starting with.

The advantage to placing the implant behind the Pectoralis Major muscle is that this adds an extra layer of the patient's own tissues over the implant. This approach is called the "Submuscular" or "Subpectoral" approach. This technique generally leads to a more natural result, a softer feel and a reduction in the incidence of Capsular Contractures. This technique does require more skill and slightly more operating time in order to create the proper pocket. Of note, is that the muscle does have to be cut for a short distance at its lower most attachments, as this will allow the implant to be positioned correctly. Patients will not even be aware that the muscle was cut, as they will still be able to use their arms normally and perform all activities. The muscle does not cover the implant on the outer or lateral side of the chest, because the muscle does not extend out that far.

Some surgeons still prefer to place the implant above the muscle, behind breast tissue alone. This approach, called the "Submammary" technique, is sometimes used in women who are larger to begin with. This technique is probably best employed when there is a larger volume of breast tissue available to fully cover the implant. This technique is often employed when using a Silicone implant. The disadvantage of the "Submammary" approach is that the implant is usually more easily felt all the way around.

Either technique can give a beautiful result provided that the correct choice is made based on the individual woman's body and that the surgeon exhibits proper skill in creating the "Pocket" for the implant to sit in.