Problems Arising from Breast Implants Below the Muscle

1.Placement of implants deep to the pectoralis muscle hurts more and has a longer convalescence.

2.Using the pectoralis muscle will distort the implant temporarily while the muscle is engaged.

3.”Bottoming out” is more likely when implants are under the muscle.  The vector of force from the pectoralis muscle referred to in no.2 over time can stretch the soft tissues and create a situation where there is too much breast implant volume in the bottom half of the breast.

4. Closed capsulotomy, although frowned upon by the manufacturers, is often impossible in submuscular implants.  Closed capsulotomy is a non-operative release of capsular contracture performed in the office (takes about a minute). In many patients it can avoid a trip to the operating room.

5. Patients with modest ptosis (droopiness) desiring breast augmentation often do not need a concurrent breast lift as the enhanced volume will camouflage the slightly droopy breast. Subglandular placement is a better choice in this clinical situation.

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