Choice of above or below the muscle insertion for breast augmentation

Good Day,

I’m Dr. Bill Reynolds and today I would like to talk to you today about some basic considerations for breast augmentation. Probably the most important question that women will be asking is, “Do you place this above or below the muscle?” The muscle they are referring to is the pectoralis major muscle. It is a very flat muscle that inserts on the rib cage, sternum, and clavicle, which is the collar bone. The muscle is very fan shaped muscle that attaches to the arm and it is important for arm movements such as during skiing. What we do is place the implant below that muscle, or we place it above the muscle.

The decision is dependent upon so many things:  the anatomy, what the patients desires are, are we using saline, are we using silicone? Imagine a woman is as flat as a wall; that woman should probably place the implant below the muscle, especially if it is a saline implant. The reason for that is, if you place a saline implant above the muscle then the partner or patient could see or feel the edge of the implant. So if a woman likes to wear a bikini or a low-cut evening gown, the implant would probably be seen or felt. However, if you place the implant below the muscle then to feel it, it would have to go through all of the layers:  skin and muscle. It is a much better solution.

Patients who would put it above the muscle are usually patients who have substantial breast tissue to cover the implant. For example, if a woman is already a size C and wants to augment her breast size to a large C or D, she would have sufficient breast tissue to place the implant above the muscle so no one could see it or feel it.