Dr. Michaels' Blog

Breast Augmentation 101: Pocket Placement , Over or Under The Muscle

By April 10, 2013 April 13th, 2013 No Comments

Deciding to have a breast augmentation involves a lot of decision making.  What kind? What shape? How big?  A crucial but perhaps not so obvious decision is where to place the pocket that will hold the implant.  Should it go over or under the pectoral muscle?

This decision is not trivial.  It impacts recovery, post-op activity level and the possible need for additional surgery. Pocket placement may be one of the most important decisions you and your plastic surgeon have to make when planning breast augmentation.

Under-the-muscle, or subpectoral, placement of the implant has several advantages. The overlying muscle will conceal the upper pole of the implant and give the breast a more natural take off from your shoulder, avoiding the “stuck on” look.

The muscle also acts as barrier between the implant and the breast tissue. This barrier helps decrease the body’s reaction to the implant, lowering the incidence of capsule formation and scarring that can move the implant and cause pain. The barrier also decreases the appearance of rippling of the implant.

Under-the-muscle isn’t the right choice for every breast augmentation.  Breast shape is important. If the breast has a significant droop, it will be lower than the pectoral muscle. With an under-the-muscle pocket, the breast tissue may hang off the implant and look unnatural. The remedy is either to lift the breast, or use an over-the-muscle technique.

The advantages of over-the-muscle placement are less pain, quicker recovery and the possible avoidance of a lifting procedure.

Pocket placement is only one of the factors impacting breast augmentation.  Read my blogs on sizing, silicone versus saline and lifting procedures.