Better to have breast implants added above the muscle?


One doctor recommended that I have implants placed above the muscle. What are the reasons for this as opposed to under the muscle?


In my opinion, it is 2012. That means that there are really no reasons to place implants above the muscle. Placing implants above the muscle particularly in patients with insufficient soft tissue coverage is a setup for visible rippling in the upper parts of the breasts, which can be easily seen in bikini tops or tank tops. Also, it has been proven for many years that Silicone implants placed above the muscle have a higher chance of forming hard scar tissue capsules around them.  Finally, it has been proven for almost a decade now that mammograms are not made less sensitive when implants are placed under the muscle. This has not been proven for implants placed above the muscle. The lifetime incidence of breast cancer in American women is 1 out of 7, so I really feel that nobody has any business placing implants in front of the muscle anymore. As I explain to patients, I would never do it in a family member, so I would never do it in a patient either. The reason that implants were placed above the muscle at one time was that it was a technically easier operation that was less discomfort. But, that is with old techniques. Today, the average breast augmentation in my hands only takes 30-45 minutes, and patients usually only take pain medicine the night of surgery. Some do not take it at all. It is hard to know how it could get any better from that anyways, so why would we expect all those risks of putting an implant above the muscle when there is really no benefit in the current day and age.