Breast augmentation: should your plastic surgeon go under or over the muscle?
The decision to go over or under the pectoralis major muscle when performing breast augmentation is a hotly debated topic amongst plastic surgeons. Recent studies reported that capsular contracture or scarring around the implant was decreased when performing breast augmentation under the muscle. While this may be true in some situations, it may also cause deformities such as the “double bubble.”
When there is enough breast tissue, I like going over the muscle. There is less distortion of normal anatomy, less pain, and a more natural appearance. I find that there is no significant difference in capsular contracture especially when following my special exercises after surgery.
When patients have very flat breasts with little tissue, I recommend performing breast augmentation under the muscle. This provides the needed padding between the implant and the skin to avoid feeling and seeing the implant edge.