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What is the Best Placement for Breast Implants?

An important anatomical issue to discuss is whether to put the implants below/deep to the breast tissue (SG=sub glandular) which is above/superficial to the pectoralis major muscle or below/deep to the pectoralis muscle (SM=submuscular). The pectoralis muscle attaches to the upper arm, fans over the upper chest/breast and attaches to the collar bone (clavicle) and the cleavage area (sternum) and part of the ribs. When the implant is placed in the SM position, the muscle covers the upper and inner implant creating smoother transitions in these areas. This is the upper/inner breast shape most women want, but not all. Implants above the muscle, in the SG position can have more of a stepped-off look in these areas. 

But the most important reason to place implants in the SM position is that those in the SM position are associated with almost half the amount of capsular contracture (hardening) than those in the SG position. The majority of breast surgeries we do at OC Breast Surgery are revisional breast surgeries from elsewhere, and we revise 99% of them into the SM position. A scar capsule is created by the body around every type of implant, and we want the capsule to be thin like Saran Wrap. 

The second rule of scar is that scars always contract. Sometimes they contract a small amount and other times there is significant contracting of the scar that occurs. Skin scars indent when they contract and some of your friends or family members might have examples of this. When the scar capsule that forms around the entire breast implant contracts more than desired, then it tries to shrink smaller than the implant and this makes it feel hard, sometimes very hard, to the touch. If one does secondary surgery and cuts the capsule, the implant and capsule are both soft. The hardening occurs from the capsule contracting around the implant. 

When the implant is in the SM position, the muscle tends to move the implant around during the first weeks/months when the capsule is forming and therefore the capsule forms bigger than it would otherwise as the body thinks the implant is bigger than it really is. We take that a step further and open the SM space up to where the muscle attaches to the clavicle and cleavage. We then have you move the implant around in specific way to displace the implant around the SM space to have the body form the capsule larger than the implant, but not beyond the desired lower breast curves. You will have great confidence that we have maximized the chance that you will stay ‘soft’ without capsular contractures when you can easily move the implant around in the first few weeks and months. With clinically ‘hard’ breasts (with significant capsular contractures), the implants can’t be moved.