Breast Augmentation Surgical Photos
Photos provided by Dr. Thomas M. DeWire
The photo below represents complete submuscular placement. The silicone implant is the dark object in the pocket below the muscle.
This was a capsule release procedure (capsulectomy), and demonstrates the lower pole muscle and fascial coverage (rectus muscle and fascia) with complete submuscular placement.
The photos show the site of the incision, and the repair of the rectus muscle after it was cut to allow entry into the submuscular pocket created at the time of original trans-ax placement. The incision is well below the lower margin of the pectoralis major muscle.
This next photo provides a reference to the position of the (crease) incision relative to the breast and trunk.

Complete submuscular placement explained by Dr. DeWire
"Regarding implant placement via the axilla. The bulk of the muscle that covers the implant is Pectoralis and Rectus, with most of the lateral coverage by fascia lifted off the pectoralis minor and serratus muscles, along with fascia swept laterally from the back side of the Pectoralis major. This fascia will lift some of the muscle fibers of the serratus anterior, but not the whole muscle. I have lifted the muscle itself on many occasions for breast reconstruction after mastectomy, and for placement of implants via crease or areola routes. For very large implants, the fascia must be torn to allow placement of those implants, as it can only stretch so much. Tearing that fascia to place oversized implants is one of the reasons that large implants may then not be well supported, and thus are more likely to displacement downward or laterally. In redo surgeries, with implants over the muscle, or only partially under the muscle, there is not always room to raise the rectus muscle and serratus muscle, and obtain complete coverage over the implants, especially if they are large. In that case sometimes partial submuscular placement must be accepted, or smaller implants used, or a portion of the existing back wall of capsule preserved, and used as a fibrous tissue flap to cover the implant, and bridge the distance between the muscles."
Courtesy of Dr. Tom DeWire