Sub-pectoral placement is one of the most common methods used in breast augmentation surgery. This technique is a primary option for individuals seeking to enhance the size and shape of their breasts. The choice of implant placement is based on a patient’s body type, implant style, and desired aesthetic outcome. Understanding the different placement methods helps ensure an informed decision.
Defining Sub-Pectoral Placement
The term sub-pectoral describes the positioning of the breast implant beneath the chest wall muscles, specifically the pectoralis major. The implant is placed in a pocket created between the chest muscle and the rib cage. This placement utilizes the patient’s own musculature to cover the implant in the upper chest area.
In many cases, the procedure is performed as a “dual plane” augmentation, which is a variation of the sub-pectoral technique. Dual plane placement involves releasing the lower section of the pectoralis muscle from the chest wall. This allows the upper portion of the implant to rest under the muscle, while the lower portion sits only under the breast glandular tissue. This hybrid approach is designed to combine the benefits of muscle coverage at the top with a more natural drape at the bottom of the breast. The surgeon may also manipulate other surrounding muscles, such as the serratus anterior or rectus fascia, to achieve full or partial muscle coverage.
How Sub-Pectoral Differs from Other Methods
Sub-pectoral placement is often contrasted with the subglandular (or pre-pectoral) method, where the implant is placed directly behind the breast tissue and in front of the chest muscle. Placing the implant under the muscle provides an extra layer of soft tissue over the implant, which is a significant functional benefit.
This muscle coverage helps to mask the edges of the implant and reduce the visibility of rippling (visible waves), particularly with saline or thinner silicone shells. This masking effect makes sub-pectoral placement a frequent choice for patients who have minimal natural breast tissue. The presence of the muscle also helps to push the breast tissue forward, contributing to a more natural and gradual slope in the upper part of the breast.
Subglandular placement is generally less invasive and may result in a quicker recovery, but it can lead to a more “stuck-on” or rounded appearance, especially in the upper pole. For patients with sufficient natural breast tissue, the subglandular method can still provide a natural result because their own tissue provides the necessary coverage. Without that natural padding, sub-pectoral placement is preferred to achieve a smooth transition from the chest wall.
Surgical Technique and Immediate Recovery
Creating the sub-pectoral pocket requires the surgeon to dissect and manipulate the pectoralis major muscle. During the procedure, the muscle’s attachments to the lower ribs and sternum are typically released to create the necessary space. This release is a defining feature of the sub-pectoral technique, particularly in the dual plane approach, as it allows the implant to settle into a lower, more natural position.
Access to the surgical site is most often achieved through an inframammary fold incision, which is placed in the crease beneath the breast. Other incisions, such as those around the areola or in the armpit, may also be used depending on the surgeon’s preference and the patient’s anatomy. Once the pocket is created, the implant is carefully inserted and positioned beneath the muscle.
The immediate post-operative experience for sub-pectoral augmentation is different from subglandular placement due to the muscle involvement. Patients commonly report significant tightness, pressure, and soreness across the chest, often described as a heavy sensation. This is a direct result of the muscle being lifted and stretched to accommodate the implant. Recovery time is generally longer, and patients must adhere to strict activity restrictions, especially avoiding strenuous use of the chest muscles, for several weeks to allow the muscle to heal and the implant to properly settle.
Aesthetic and Clinical Characteristics
The long-term outcomes of sub-pectoral placement include several clinical advantages. Evidence suggests that placing the implant beneath the muscle may be associated with a lower risk of capsular contracture. Capsular contracture is a complication where the scar tissue around the implant tightens and hardens, potentially causing pain and distortion.
Sub-pectoral positioning also offers benefits for medical imaging, as it displaces the implant away from the majority of the glandular tissue. This can make mammography easier and more accurate for breast cancer screening, as the implant interferes less with the compression and visualization of the breast tissue. Specialized views, known as Eklund views, are still necessary to ensure adequate viewing of all breast tissue.
A key aesthetic characteristic unique to this placement is the potential for dynamic distortion, sometimes called implant animation. This occurs when the pectoralis muscle contracts, such as during exercise or pushing movements, causing the implant and the breast mound to temporarily shift or change shape. Patients should understand that this movement is a possibility. The muscle coverage, while offering a natural look at rest, means the implant is directly influenced by the muscle’s function.