Breast Augmentation / Breast Implant Placement
Complete Submuscular (Total sub-musculofascial) Breast Implant Placement

 

• Complete Sub-muscular (a.k.a. complete unders, total sub-muscular, total sub-musculofascial, and full unders) 
  
  *When discussing under the muscle placement with your surgeon, make sure he or she clarifies either PARTIAL or COMPLETE sub-muscular placement. 
  
  Implants placed completely beneath the muscle are NOT totally behind the pectoral muscles. The top 2/3 of the implant is behind the pectoral muscles and serratus muscles, and the lower 1/3 is behind the fascia, which is the connective tissue that connects the pectoral, serratus, and upper rectus abdominal muscles. Having the implants completely beneath the pectoral muscles ALONE is not anatomically possible. 
  
  There are rumors that complete sub-muscular placement is not possible no matter how the surgeon performs the surgery. This is simply not true, and don't let anyone tell you otherwise. 
  
  Complete sub-muscular placement can be achieved via the transaxillary, periareolar, or inframammary fold incision. However, when going with the transaxillary incision, the muscles and fascia can be left in tact. They do not have to be cut or dissected in any way. This is not so with the periareolar and crease incision. With these two incisions, the muscle must be dissected in one way or another, in order to place the implant behind it. Of course, there is the method of simply cutting, and afterwards, it is closed up with sutures, or allowed to heal on it's own.
  
  Currently, complete sub-muscular placement is not widely used, though it is gaining increased popularity. 
  
  
  
  Pros:
   

• The implant is fully covered, by the muscle and fascia, which helps to camouflage the edges of the implant, as well as ripples in the implant. While visible rippling is possible with all three placements, having complete submuscular placement has the least risk of visible rippling.

• The fascia serves as support to the lower pole, whereas with partial sub-muscular placement, the skin tissues support the weight of the implant.  Complete unders serve as sort of an "internal bra". 

• Lower risk of capsular contracture. 

• Better mammogram readings (versus over the muscle implants).

• Lower risk of bottoming out.
  
  
  
  
  Cons:
   

• More post-op discomfort. 

• Breasts tend to sit a bit high at first, until the muscle relaxes. 

• Implant distortion when the pectoral muscle is tightly flexed, which is also try with partial submuscular placement. 

• If your breasts are widely spaced, it may be more difficult to create cleavage, especially with textured implants.
  
  

Related links:

Breast Anatomy
Muscle Anatomy
Dr. DeWire's explanation on complete submuscular placement, with photos

 

 

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