Breast Augmentation Under Or Over The Muscle Breast Implants

Breast Augmentation

Pocket placement for breast implants     

Breast augmentation involves the creation of a pocket that allows for the placement of the breast implant. The pocket can be made in one of two places: under the breast itself (sub-mammary or sub-glandular), or under both the breast and chest muscle (sub-pectoral or sub-muscular). This page will review the two options for the patient.

Please see the main breast augmentation webpage also.


This is generally the most common approach and is preferred in most cases by Dr Rieger. In the sub-pectoral approach (also known as sub-muscular), the implant is placed under both the breast and chest muscle. The chest muscle covers the upper two thirds of the implant, while the bottom third is covered by your natural breast tissue. This allows for a tear-drop shape to the breast that looks more natural.

 The sub-pectoral approach is recommended for women who have minimal amounts of existing breast tissue. Because the chest muscle covers the majority of the implant, it will act like extra padding, making the implant less visible through the skin and ‘feel-able’. Implants ripple along the edges and the extra coverage helps reduce this especially in the upper two thirds and cleavage area which is covered by the muscle.

Other advantages of sub-pectoral placement include

a. a lower risk of capsular contracture (a condition that is characterized by an undesirable hardening of the breasts). The scar capsule around the implant will be less likely to become thickened and hard if the muscle over the implant is in motion.

b. making mammograms easier to read (which can be beneficial for a woman with a family history of breast cancer). The muscle acts as a divider keeping the implant towards the rib cage away from the breast tissue which needs to seen on the mammogram.

c. reduces a step off or bulge in the upper breast allowing a smoother more natural tranistion.

d. reduces the risk of migration of the implant downwards. This is called bottoming out of the implant. The technique that Dr Rieger uses perserves the lower border of the muscle attachments in the breast fold.  This  muscle “sling” acts to support the implant, “just as an underwire bra supports the breast”. If the implant only has skin and some breast tisssue in the fold for support the implant may over time sag downward below and throught the fold.


In sub-mammary implant placement (also known as sub-glandular), the breast implant is placed between the breast tissue and the chest muscle.

This position is should be recommended for women who already have a fair amount of breast tissue. A moderate amount of breast tissue will help conceal an implant placed in a sub-mammary pocket.

This placement is sometimes recommended in patient with a mild degree of breast droopiness (ptosis).  In these cases the implant can “descend” into the “droopiness” ptotic lower breast and help improve the appearance of sag.  However, if the amount of droopiness is moderate or significant than this approach is not recommended. A lift instead should be performed to correct droopiness. Otherwise the risks of  bottoming out or double bubble deformity may increase.

Sub-mammary pocket placement may also recommended for women with unusually shaped breasts, as the implants will help to change the shape of the breast better than implants placed in a sub-pectoral pocket.

Finally, professional, competitive body builders and fitness models are usually better off with implants placed above the chest muscle as well since animation(motion) of the implant may be noticable.

 Keep in mind that there is no single approach that is ideal for every patient. Dr. Rieger will help you decide which implant pocket placement is best for you prior to surgery, taking special care to select one that will achieve your personal goals and expectations.

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10111 East 21st Street North Suite 402, Wichita, Kansas 67206

Dr Rieger Plastic Surgery in Wichita Kansas. Specializes in breast implants and rhinoplasty surgery as well as all cosmetic surgery of the face, breast and body. Dr. Rieger has provided the content of this website for informational purposes only. The website is not intended to provide medical advice nor does it constitute a doctor/patient relationship. Please see HIPPA/privacy, email, texting, communication, and legal statements

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