Breast Implant Placement Options

Breast implant Placement – where the implant is placed on the chest wall – can determine how it appears and functions in the tissue. The three ways used by Dr. McMenamin to place implants during breast augmentation are as follows:

Submammary Breast Augmentation

If you and Dr. McMenamin have decided to place the implants above the pectoralis muscle and above the fascia of the muscle, a different set of risks apply. During contraction of the muscle, the implants may temporarily pull upward. The influence of gravity may play a bigger role in stretching the skin causing the implants to “fall.” The risk of rippling is higher particularly in the upper and central breast regions.

There is greater disruption of the skin attachments to the chest wall and therefore there is less support of the implant with greater stress on the tissue. Stress on the skin over time can result in a “rock-in-the-sock” deformity. That is, the implant may look like a rock in the bottom of a loose bag of skin. The supporting ligaments, called Cooper’s ligaments, are destroyed when the pocket for submammary placement is developed.

Subpectoral Breast Augmentation

Placement of the Implant (Under the Muscle and Fascia)

If you and Dr. McMenamin have decided to place the implants under the pectoralis major muscle, a unique set of risks applies. During flexion of the muscle, the implants may temporarily be flattened and/or pulled upward and outward distorting the shape of the breast. Implants can be placed under the muscle in thin, small-breasted women or in women who have thin tissue coverage in the upper breast regions. The muscle may provide more "cover" and some dynamic tension over the implant.

Placing the implants under the muscle may reduce visible rippling in the upper medial breast regions but with the risk of distortion of the breast during flexion of the muscle. Cooper’s ligaments remain intact during development of the implant pocket and there is more implant support against drooping.

Post op bra support is always recommended. It is important to note that only the top approximately ½ of the implant is covered by the pectoralis muscle. The muscle overlying the upper part of the implant can cause an unnatural fullness over the top of the breast.

Subfascial Breast Augmentation

Placement of the Implant (Over the Muscle, Under the Fascia (thick fibrous covering) of the Muscle and Under the Breast Tissue)

This is a relatively new way to place the implant and, in our experience, the way most patients get the best result with the least amount of distortion with movement. The subfascial placement gives you most of the benefits of placement under the muscle (better support of the implant, less trauma to the breast tissue, less rippling than submammary placement) but also gives a more natural shape to the breast and less distortion with movement.

In our experience, patients have less postoperative pain and a quicker recovery than with subpectoral placement. There may be a slight increase in risk for rippling with subfascial placement but much less than submammary placement. When compared to subpectoral placement, the subfascial placement has almost always given a better post op result.

During a consultation, Dr. McMenamin can explain the various options in breast implant placement. Contact the Cosmetic Surgery Center of Sacramento if you have any questions about breast implants and breast augmentation. Our practice is located east of Sacramento, so it is also very convenient for residents of Roseville, CA. Please call us at 916-564-8888 or send an email using the online contact form to set up a consultation.