Breast Implant Placement and Incisions: Over, Under or Dual Plane?
By Dr. Sushrut Tated, plastic surgeon · Updated
Breast implant placement means where the implant sits: in front of the chest muscle (subglandular), behind it (submuscular), or partly behind it (dual plane). The choice depends mainly on how much breast tissue covers the implant. The incision is usually in the fold under the breast. Both decisions are made at a breast augmentation consultation.
Dr. Sushrut explains breast augmentation
What are the options for breast implant placement?
The implant can be placed in one of three planes, or “pockets”:
| Placement | Where the implant sits | Advantages | Trade-offs |
|---|---|---|---|
| Subglandular (in front of the muscle) | Behind the breast tissue, in front of the pectoralis muscle | No muscle movement of the implant; often quicker early recovery | Edges and rippling more visible if tissue is thin |
| Submuscular (behind the muscle) | Behind the pectoralis muscle | More cover over the upper implant | More early discomfort; implant can move when the muscle contracts |
| Dual plane | Upper part behind the muscle, lower part behind breast tissue | Upper cover with a natural lower curve | Some muscle movement still possible |
| Subfascial | Under the thin layer covering the muscle | A little extra cover without muscle division | Limited extra cover |
The dual-plane approach was developed to combine upper cover from the muscle with a natural lower breast shape, and it is widely used for women with thin upper breast tissue.
How is the right plane chosen?
Your surgeon measures and examines:
- Tissue thickness: if a pinch of the upper breast is thin, muscle cover helps hide the implant edge.
- Breast shape and sagging: some mild sagging can be addressed by how the dual plane is set up; more sagging may need a lift.
- Your activities: women who do a lot of upper-body training may notice muscle movement more.
- Implant type and size: larger or heavier implants need adequate support.
Where can the incision be made?
| Incision | Location | Advantages | Trade-offs |
|---|---|---|---|
| Inframammary (breast fold) | In the crease under the breast | Most control of the pocket; avoids breast tissue; easiest for later revision | Scar in the fold, hidden by most bras |
| Periareolar | Along the lower edge of the areola | Scar can blend with the colour change | Passes near ducts and nerves; small areolas limit implant size |
| Transaxillary | In the armpit | No scar on the breast | Less direct control; scar may show in sleeveless clothes |
The fold incision is the most commonly used today because it gives the surgeon a clear view of the pocket and keeps away from the breast tissue.
What happens during the operation?
- Markings and measurements with you standing.
- General anaesthesia.
- The incision is made and the chosen pocket is created with careful control of bleeding.
- Sizers may be used to check shape and symmetry with you sitting up.
- The implant is inserted with minimal handling to reduce contamination.
- The tissues are closed in layers and a support bra is applied.
The breast augmentation page explains preparation, recovery and the risks of implants.
Does placement change the risks?
All placements share the main implant risks: capsular contracture (tightening of the scar capsule), rupture, infection, malposition and, rarely, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Placement affects some of them: thinner cover makes rippling and visible edges more likely, while muscle cover adds early discomfort and the possibility of movement with muscle contraction. Your surgeon will explain how each applies to you.
Myths about implant placement
- “Under the muscle is always more natural.” It depends on your tissue; thick tissue can give a natural result in front of the muscle.
- “The armpit incision leaves no scar.” It leaves a scar in the armpit instead of the breast.
- “Placement does not matter if the size is right.” Placement and size are planned together.
Planning your choice
Bring questions about placement and incisions to your consultation, and ask your surgeon to explain why they recommend a particular plane for you. Read silicone vs saline breast implants to understand implant choices, and the breast augmentation page for recovery and safety information.
Frequently asked questions
Is it better to put implants over or under the muscle?
Neither is right for everyone. Placing the implant partly under the muscle gives extra cover when breast tissue is thin, which can make edges less visible. Placing it in front of the muscle avoids the muscle moving the implant and may be considered when there is enough natural tissue.
Does implant placement affect recovery?
Usually. Placement under the muscle tends to cause more tightness and soreness in the first weeks, because the muscle is stretched. Placement in front of the muscle is often more comfortable early on.
Which incision leaves the least visible scar?
The fold under the breast hides the scar in the natural crease for most women. A cut at the lower edge of the areola can blend with the colour change. An armpit incision avoids a scar on the breast but gives less control of the pocket.
Can the incision affect breastfeeding?
An incision around the areola involves cutting near the milk ducts and nerves, so it may slightly increase the chance of affecting breastfeeding or nipple sensation. The fold incision avoids the breast tissue.
What is animation deformity?
When an implant lies under the muscle, contracting the chest muscle can move or distort the breast. It is usually mild but can bother active women, and it is one reason the plane is chosen carefully.
References
- Breast Augmentation (StatPearls). NCBI Bookshelf, StatPearls Publishing.
- Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Tebbetts JB, Plastic and Reconstructive Surgery (reprint).
- Risks and Complications of Breast Implants. U.S. Food and Drug Administration.
