What is the difference in implants placed in front of and behind the muscle?

Recently a patient asked on www.realself.com the difference in the implants placed behind and in front of the pectoral muscle. The following was my answer:

Sometimes they are placed under the breast tissue (between the muscle and breast). They are never placed within the breast gland itself.

Terms: Behind the muscle – subpectoral, submuscular

           In front of the muscle – subglandular, prepectoral

Plastic surgeons began placing the implants behind the muscle for two reasons:

1. To reduce visible wrinkles in the implants, particularly with saline implants and in thin patients.

2, To reduce encapsulation. Implants can encapsulate either in front or behind the muscle. Maybe there is a slight reduction in encapsulation behind the muscle. Statistics vary on this subject.

Advantages of implants in front of the muscle:

1. No distortion when the pectoralis muscle is flexed, called dynamic distortion. In the subpectoral position, flexing the pectoralis muscle flattens the implant at the top and can make it “jump.” This can look strange, and this phenomenon doesn’t exist when the implant is subglandular.

2. A more natural result when the patient has some sagging.

3. Generally, less discomfort in the post-operative period.

Disadvantages of subglandular (prepectoral) implants:

1. If encapsulation occurs, there may be more distortion and visible wrinkles unless the patient already has ample breast tissue.

2. Possibly slightly higher encapsulation rate.

Bottom line: Each patient has specific needs and this will dictate what your plastic surgeon’s decision on implant position. Both positions are good but, as in most things, not perfect. In my practice anyone with minimal breast tissue or those who are very thin receive the subpectoral position. Athletes, on the other hand, usually get the subglandular position because excess use of the pectoral muscle seems to encourage encapsulation and weakens the pectoral muscle with subpectoral implants.

Hope this has helped you understand the pros and cons of the subpectoral and subglandular implant positions.

E. Ronald Finger, MD, FACS