One of the most important decisions in breast augmentation surgery — and one that is often misunderstood. Here is how to think about implant placement based on your anatomy and goals.
Breast implant placement refers to where the implant sits relative to the pectoralis major muscle — the large chest muscle that runs from your sternum to your upper arm. There are two primary options, each with meaningful differences in how they feel, look, and behave over time.
The implant is placed beneath the pectoralis major muscle. More precisely, in the most common variation of this technique (called dual-plane placement), the upper portion of the implant sits under the muscle while the lower pole sits beneath the breast gland. This is the most widely used placement in modern breast augmentation.
The implant is placed above the pectoralis major muscle, behind the breast gland. There is no muscle covering the implant. This placement is faster surgically, involves less initial discomfort, and allows the muscle to move freely without affecting the implant. It is the right choice for specific patients and the wrong choice for others.
A third option involves placing the implant beneath the pectoralis fascia — the fibrous tissue that envelops the muscle — but above the muscle itself. This provides a thin extra layer of tissue coverage compared to pure subglandular placement. It is not widely adopted and the evidence for meaningful clinical benefit over standard subglandular placement is limited. Dr. Newman evaluates this option on a case-by-case basis when relevant.
The single most important factor in placement selection is the amount of natural breast tissue you have, specifically the thickness of the tissue over the upper pole of the breast. This determines whether you have sufficient native tissue to create a natural-looking result over an implant without muscle coverage.
During consultation, Dr. Newman performs a pinch test on the upper pole: pinching the tissue at the top of the breast between thumb and forefinger. If this measurement is less than 2 centimeters, there is insufficient tissue to adequately cover an implant in the subglandular position. In this scenario, the edges of the implant would be visible or palpable, particularly in the upper inner portion of the breast, and the result would look artificial. Submuscular placement uses the pectoralis muscle as an additional layer of coverage.
If the pinch test shows 2 centimeters or more, subglandular placement may be appropriate depending on other factors including the patient's aesthetic goals and lifestyle.
Submuscular placement is typically the right choice when:
Subglandular placement is typically the right choice when:
The most widely used variation of submuscular placement in modern breast augmentation is the dual-plane technique, developed by Dr. John Tebbetts. Rather than placing the implant entirely behind the muscle (which creates an unnaturally high, tight appearance), the dual-plane technique releases part of the lower pectoralis muscle so that the implant occupies a pocket that is partially submuscular (upper) and partially subglandular (lower).
The result is a more natural lower pole shape with better projection at the breast crease, while still benefiting from the muscle coverage in the upper pole where rippling and visibility are most common. The dual-plane technique has become the default for most submuscular placements and is the approach Dr. Newman uses for the majority of his augmentation patients who are candidates for submuscular placement.
When the pectoralis major muscle contracts — during push-ups, chest press exercises, gymnastics, swimming, or even certain yoga poses — it pulls on the tissue above and below it. With a submuscular implant, this contraction temporarily moves or distorts the shape of the implant. This is called animation deformity or dynamic deformity.
Animation deformity is visible only during muscle contraction and does not affect the resting appearance or long-term outcome. For most patients, it is a minor inconvenience. For competitive athletes, dancers, or patients in professions where their chest is visible during physical performance, it may be a more significant consideration.
The degree of animation deformity varies by patient and is influenced by implant size (larger implants show more movement), implant profile, and the individual's muscle anatomy. A thorough consultation will include a realistic discussion of what animation deformity might look like for your specific anatomy and activity level.
| Factor | Submuscular (Under) | Subglandular (Over) |
|---|---|---|
| Best for thin tissue | Yes — muscle adds coverage | No — edges may show |
| Best for active athletes | Depends on sport | Yes — no animation |
| Upper pole appearance | Natural slope | Fuller, rounder upper pole |
| Recovery comfort | More initial tightness | Less initial discomfort |
| Rippling visibility risk | Lower (muscle coverage) | Higher (in thin patients) |
| Animation deformity | Present during contraction | None |
| Capsular contracture risk | Slightly lower | Slightly higher |
| Mammography | More tissue visible | Slightly less tissue visible |
| Surgical time | Longer | Shorter |
| Sagging correction | Limited without lift | Can fill lower breast envelope |
Capsular contracture — the hardening and tightening of scar tissue around the implant — is one of the most common complications in breast augmentation. Research suggests a slightly lower rate of capsular contracture with submuscular placement, likely because the muscle's movement creates a massage effect that may help prevent the capsule from hardening. The difference is not dramatic, but it is an additional point in favor of submuscular placement when anatomy supports either option.
The decision between submuscular and subglandular placement also interacts with implant type selection. Highly cohesive gel implants (gummy bear implants) have a firmer consistency that reduces the visible rippling that can occur with saline or standard silicone implants in the subglandular position. This means that a patient who might show rippling in subglandular placement with a standard silicone implant might be a better candidate for subglandular placement with a highly cohesive gel — an option worth discussing in consultation.
The placement conversation happens as part of a broader evaluation of your goals, anatomy, and implant selection. Dr. Newman's consultations cover:
Placement is not a patient preference decision made in isolation — it is a surgical recommendation based on physical findings, with the patient's goals and preferences incorporated into the recommendation.
Implant placement is determined by your anatomy — and the right recommendation requires a physical examination. Dr. Newman's consultations include 3D imaging and a specific, explained recommendation for your unique anatomy and goals.
Request a ConsultationPatients exploring breast augmentation often research related wellness and health topics alongside their surgical planning. For patients managing dental health during the perioperative period, The Dental Article provides guidance on oral health considerations. Patients preparing for surgery also frequently consult resources on recovery nutrition — Nature's Zest Nutrition covers a range of wellness and gut health topics relevant to surgical recovery.