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What Surgery Type Is Right For You: Sub-Pectoral Or Pre-Pectoral

Choosing to have breast augmentation surgery involved making several important decisions. After choosing the incision type, the next step is to decide the location of the implant: above the pectoralis major chest muscle (also called the pre-pectoral or sub-mammary position), or under the chest muscle (known as sub-pectoral positioning). There are advantages to both surgery types and each option works well to address patients’ different needs and goals.

When To Choose The Pre-Pectoral Or Sub-Mammary Position

Having the implant placed in this position means that it will go above the chest muscle, directly under the skin and fatty tissue of the breast. Because the implants will be placed just under the patient’s breast tissue, the sub-mammary position works best for women who already have a reasonable amount of breast tissue. This will ensure that the implant is not visible. For women who have sagging breasts (ptosis), it is often necessary to have a breast lift (mastopexy) to place breast implants under the muscle. However, for those patients who have enough breast tissue and ptosis, it can be beneficial to place the implant above the muscle and achieve a lifted result without having breast lift surgery. There is a greater chance of visible rippling or waviness over time with this placement.

Placing the implant in the sub-mammary position will allow digital mammograms and MRI scans to properly visualize the breast, which is an important consideration for long-term health. Also, because pre-pectoral surgery is less invasive, patients can expect less pain and possibly faster recovery times. There is a slightly higher chance of capsular contracture with implants placed in this position.

When To Choose The Sub-Pectoral Position

The sub-pectoral placement of breast implants has many advantages for a wide array of body types and patient needs. This placement works well for patients with little or no breast tissue, as the chest muscle will cover and conceal most of the implant, achieving a more natural-looking and feeling result. Sub-pectoral surgery may also decrease the chances of capsular contracture (hardening) of the implants, and will be easily screened with a digital mammogram. Because the implants are placed farther from the surface of the breast, it is also less likely that you will see the implant rippling or becoming wavy over time. Note that this rippling effect is normal and expected, but will be less or not visible if placed underneath the chest muscle. Complete sub-muscular coverage is usually only preformed for breast reconstruction purposes.

The Best Of Both Worlds: Dual Plane Positioning

In a dual plane breast augmentation, implants are placed partly behind the chest muscle, and partly just under the breast tissue. While the chest muscle never fully covers implants even in sub-pectoral surgeries, the dual plane option allows the surgeon to control how much of the implant is covered by muscle, and how much is just under the breast tissue. In the most common placement (called a Dual Plane 1), the top 2/3 of the implant is placed under the chest muscle for good coverage and concealment. Meanwhile, the bottom third of the implant goes just under the breast tissue, so the tissue can gently drape around the implant and create a round, full, natural breast shape.

For this option, the amount of the implant covered by the chest muscle may be slightly altered to achieve the best result, and this can provide subtle lift for women with minor ptosis (droopiness). Dual plane placement can benefit patients with a wide range of breast types and goals. This option is particularly useful for women who have little of their original breast tissue to work with. Our patients who are fitness models and athletes have achieved excellent results with dual plane placement.


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