What to think about when having breast implants

Understanding your options

Breast augmentation is the top cosmetic surgery procedure in the UK and involves women considering where to place their breast implants.¹

Before making a decision about where you would like your breast implants it’s best to start educating yourself on your options, the risks, and the benefits. The decision on implant placement should be made together with your plastic surgeon. They will discuss with you which placement they recommend specifically for you and why.

Influencing factors

There are many factors to consider when making a decision on the position of your breast implants. These include:

the size of your breast implants and your desired shape of your breasts

your body size

recovery time and your tolerance to post-operative discomfort and pain

your lifestyle

your own goals and expectations

Where can breast implants be placed?

Breasts can be made larger by placing an implant:

1. Over the muscle / behind the breast
2. Complete under the muscle
3. Partial under the muscle / dual-plane technique

There are advantages and disadvantages to each placement. Your plastic surgeon will help you decide which method of placement is right for you.

1. Over the Muscle or Subglandular Breast Implant Placement

Breast Augmentation: Directly behind the breast tissue, over the pectoral muscle

Your implant is directly placed behind the mammary gland and in front of the muscle.

The insertion of implants behind the breast is considered to be the simplest and the least likely to cause discomfort of all breast augmentations. It is most effective for women with slightly drooping breasts with enough natural breast tissue to cover the implant, resulting in fuller volume and better uplift.²

• Less complicated surgery as only your fat and skin are disturbed and not your muscle. This usually results in less pain and a quicker recovery.
• If you have a small amount of sag you may opt for over the muscle for some lift without a breast uplift.
• It may be easier to create a cleavage for you.
• If you are a woman who is athletic or body-builds you may prefer this placement as it prevents flexing chest muscles from interfering with the look of the implant.

• If you don’t have relatively large breasts there is a risk that the top edge of the implant will be more visible. Your breast may also look and feel unnatural.
• As very little separates your breast implant from your skin's surface rippling is more likely.
• Capsular contracture may be more likely with this placement. When breast implants are placed in the body, the body’s natural response is to form a lining or capsule around it. Often as you heal this capsule shrinks and compresses the implant causing it to feel hard or firm. This is known as capsule contracture.³
• If you have a mammography this placement makes it more difficult for the technician to obtain and read a complete image.
• With little support for the weight of your implant there is an increased risk of needing a breast lift later.
• "Bottoming out" may occur. This means that your breast implant descends too low on the chest making the nipple too high on the breast mound. If bottoming out happens shortly after surgery, it is most likely due to over-dissection of the pocket. If it materialises later on, it is usually due to the weight of the implant.⁴

2. Complete Under the Muscle or Complete Submuscular Breast Implant Placement

Breast Augmentation: Under the pectoral muscle and muscles at lower half of implant

Your implant is placed behind the breast muscle and muscles at the lower half of the implant. The result is that the implant is fully covered by muscle.

The insertion of implants behind the breast muscle provides more padding. This is an important consideration for slender women and those with very little breast tissue where the edge of an implant may be detectable through the skin. The muscle provides extra cover and helps to hide the implant and so is strongly recommended for those whose ribs are visible.²

• Complete under the muscle placement has the least risk of visible rippling. The implant is fully covered by your muscle which helps to camouflage the edges and ripples of the implant.
• A more natural shape. Your pectoral muscle pads the upper part of the implants making the upper breast slope appear more smooth and gradual.
• The lower muscle offers support to the lower part of your implant acting as sort of an "internal bra”.
• Less sagging of your breasts than with other placements as the lower muscle holds the breast implants up preventing them from sagging.
• Lower risk of capsular contracture compared to over the muscle placement.
• Better protection of your implants than if they are placed over the muscle.
• Your breast tissue is less obstructed for a mammogram, than with over the muscle. placement, giving easier access to imagery and reading the images.

• Less natural appearance if you have sag as the implant is positioned in a place above where sagging breast tissue is. It may then create an appearance of two bulges, rather than one breast.
• Implants take longer to "drop" after surgery than with partially under the muscle placement.
• Flexing of muscles when you exercise can cause the implant to contract into an unnatural appearance.
• You will have more pain and a longer recovery than with over the muscle placement. This is due to the procedure being more invasive, as well as your muscles stretching out to accommodate the implant.

3. Dual Plane Implant Placement or Partially Under the Muscle

Breast Augmentation: Under the pectoral muscle and lower half of implant not covered by muscle

The top half of your implant is placed behind the breast muscle and the lower half is left uncovered by any muscle. The result is that the implant is partially covered by muscle.

When slender women with slightly drooping breasts seek enlargement surgery, surgeons often use this combined approach combined approach. Dual plane implant placement offers patients the benefits of both techniques.²It allows the muscle to cover the implant whilst avoiding the distortion that often comes with complete under the muscle placement.

• Lower risk of capsular contracture than with over the muscle implant placement.
• Lower risk of visible rippling compared to if your implants are placed over the muscle.
• A more natural slope to the breast, instead of the "upper roundness" that can be more common with over the muscle implants
• Less distortion of the implant during exercise that is apparent with complete under the muscle implant placement.
• Your breast tissue is less obstructed for a mammogram, than with over the muscle placement, giving easier access to imagery and readings.

• Rippling possible on the bottom of implant which is still covered only by your skin or tissue.
• More pain and longer recovery than with over the muscle placement.
• Bottoming out may occur as there is less support at the bottom of your implant than with a complete over the muscle placement.
• Lack of support for the weight of your implant at the bottom creates a risk that you may need a lift later.

Talk to your plastic surgeon

Now you know about the pros and cons for each possible placement of your implants it is best to talk through with your plastic surgeon what is best for you taking into consideration your needs and preferences.

Mr Simon Mackey, Consultant Plastic, Reconstructive & Aesthetic Surgeon said “There are many things to consider if you are thinking about having breast implants, and this article describes many of them.

It is very important that you choose a reputable hospital for your treatment. Look for a surgeon who is on the GMC's specialist register for plastic surgery, and ideally a member of BAAPS (the British Association of Aesthetic Plastic Surgeons) or BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons).

Surgery needs to be tailored to you specifically and meeting your surgeon in advance allows your goals to be explored and for you to understand the limitations and potential complications of surgery.

Many different implants are available, and I advise you to choose a good quality implant from a reputable manufacturer even if it costs a little but more. Your outcome depends on careful planning, accurate surgery and great aftercare. Additionally, it is important that you follow pre- and post-operative instructions carefully to get the best possible results“.

Here you can find our guide prices for cosmetic surgery procedures.

Read more cosmetic surgery blog posts to find answers from our consultants to the most common questions including: how to choose a cosmetic surgeon, breastfeeding and implants, cosmetic surgery after weight loss surgery.

About Ramsay Health Care cosmetic breast augmentation services

Ramsay Health Care Cosmetic Surgery is a leading provider of cosmetic breast surgery in the UK.

If you are considering enlarging your breasts using implants then Ramsay offers cosmetic breast surgery procedures performed by the highest qualified and experienced cosmetic surgeons in the UK.

Please contact us if you would like to make an appointment with one of our plastic surgeons to discuss where to place your breast implants and to find more about having a breast augmentation with Ramsay Health Care.

This content is intended for information purposes only and should not replace advice that your GP or Consultant Surgeon would give you.


¹ http://baaps.org.uk/about-us/audit/1856-britain-sucks
² http://www.bapras.org.uk/resources/plastic_surgery_information_guides/breast_enlargement#

³ http://www.justbreastimplants.com/article/risks-of-breast-augmentation/preventing-capsular-contracture


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