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          Your Choices in Breast Implant Placement

          There are many decisions that you must make about your breast augmentation surgery. These include implant size and type, incision pattern and implant placement.

          Your breast implants can be placed either directly under your natural breast tissue (subglandular or over-the-muscle placement) or under your pectoral muscles (submuscular or under-the-muscle placement). These locations are often referred to as "overs" and "unders," respectively. There are some variations on these two basic placement options as well.

          The decision on implant placement should be made together with your board-certified plastic surgeon. It is based on the size of your breast implants, your body size and type, and other factors relating to your goals and expectations.

          Making this choice starts with educating yourself on the options, their risks, and their benefits.

          comparison of implants

          Image courtesy of

          "Overs" – Subglandular Placement

          Subglandular breast implant placement involves placing the implant above — or over — the muscles and fibrous tissues that line the front of the ribs and chest wall. The edges of your implants may be visible if you have little or no natural breast tissue, little body fat, and thin skin. That said, some women prefer the high-and-tight look that can be achieved with this type of placement.

          Subglandular placement can correct mild cases of breast sagging (ptosis). However, it will not lift a breast that sags significantly. Only a breast lift can help perk up such breasts. There is less pain and a shorter healing time when implants are placed above the muscles, because the chest muscles have not been traumatized by surgery.

          Another plus: subglandular placement allows for more natural movement as you walk or use your chest muscles. By contrast, "unders" may squeeze or contract as the chest muscles are used.

          "Unders" – Submuscular & Subpectoral Placement

          There are essentially two procedures involving unders: full submuscular placement and subpectoral placement.

          Full submuscular breast implant ("complete unders") placement involves placing the breast implant fully under the pectoral muscles and other muscles and tissues.This type of placement is not as common as other placements.

          With full submuscular implant placement, the implant is placed below the pectoralis major, the pectoralis minor, the serratus and the fascia (the connective tissue covering the muscle) of the rectus abdominal muscles of the abdomen. A small portion of the breast implant (toward the lower inner edge) is not covered. The increased coverage provided by full submuscular placement may stave off rippling.

          Subpectoral breast implants — also called unders, partial unders, or partial submuscular implants — are placed behind the breast tissue and partially under the pectoral and other chest muscles. The lowest part of the pectoralis major muscle is cut so that the upper part of the implant sits deeply beneath the muscle. The lower part of the implant sits beneath the breast tissue.

          The risk of developing capsular contracture may be lower with subpectoral placement. Another advantage of this placement method is that the breast can have a more natural slope on the top if you have little natural breast tissue.

          The main disadvantage of unders and full unders is a longer recovery time. These implant placement options also affect how many views (or images) of your breast can be taken during your routine mammogram.

          You should leave your consultation knowing how your implants will be placed. Make sure your surgeon explains the risks and benefits of each type of placement, and why he or she is recommending overs or unders for your breast augmentation surgery.

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            Joseph A. Mele, MD, FACS

            130 La Casa Via
            Building 2, Suite 206
            Walnut Creek, CA 94598
            (925) 943-6353
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          • 95 Scripps Drive
            Sacramento, CA 95825
            (916) 929-1833

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            A.J. Khalil, MD

            A.J. Khalil, MD
            436 North Roxbury Dr
            Suite #207
            Beverly Hills, CA 90210
            (323) 856-1941
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