The decision as to whether an implant is best placed under (usually partial under or dual plane) or over the muscle is one that is best decided at consultation. In general very skinny people with minimal breast tissue do better with implants under the muscle. When implants are behind the muscle they are normally fixed higher and more firmly to the chest wall. They also move when the muscle contracts. I tend to use teardrop shaped (anatomical) implants behind the muscle.
Implants placed in front of the muscle tend to hang, move, feel and (very importantly) age more like a natural breast.
My feeling is that if a patient has the anatomy to support the implant being placed in front of the muscle then this is normally the best place for it. This is after all the natural pocket occupied by the mammary gland. I tend to use round shaped implants in front of the muscle.
An experienced surgeon should be able to advise you appropriately.
The usual answer is that it all boils down to thickness of soft tissue coverage (determined by skin pinch) and to a large extent it does, however there are several other factors which figure in the decision.
This conventional wisdom is largely based prior to the advent of form stable (less ripply) implants and holds very true in extremely thin ladies.
After 20 years of medical practice and 10 years NHS consultant and private practice the basis upon which I take the decision to encourage patients to have either unders (usually partial unders/dual plane) versus overs has evolved quite far.
I do not think that there is a correct plane for every patient indeed certain patients would have a good static (i:e photographic) result with a round or teardrop shaped implant either in front of or behind the muscle.
What I would definitely say to you though is that the enhanced mobility of a subglandular (over) implant means a more natural dynamic result. The implant will move with the breast gland as it is filling the natural plane that the glandular tissue normally occupies.
So an ‘over’ implant will hang, wobble, feel and age more like a normal breast than an ‘under’.
The enhanced tissue adherence seen with ‘unders’ means that in addition to being prone to move with pec major contraction the implants will tend to be rather fixed to the chest wall and not flop to the side when the patient lies down in bed or on a sun-lounger. This is both an advantage and disadvantage as unders will be more gravitationally stable through this enhanced tissue fixity. It can also make them more prone to development of double-bubble as the breast ages and droops and the implant stays up high.
In a nutshell – for the most natural result go for overs if you can. Unders are great in certain patients but not necessary unless you are super skinny.
xx
