This is the sixth in a series of articles by board certified plastic surgeon, Dr. Kimberly Short regarding myths and truths about breast augmentation. In this article, Dr. Short addresses whether placement of a breast implant under the chest muscle actually prevents sagging of the breast.

Another common myth about breast augmentation is that placing the implant under the muscle will “hold the implant up” and make the breast sag less, and also that implants placed in the subglandular position will sag more over time as compared to implants placed under the muscle.

Although there is some controversy among surgeons, many do not believe that placing the implant under the muscle will prevent sagging. As we discussed in the previous blog, the muscle tends to push the implant out and downward if the lower muscle border has been divided. If the muscle fibers are not divided at the lower edge, the implant is held upward, but the movement of the implant with muscle contraction will be extreme and the implant is displaced toward the armpit and often can sit in a position, which is too high. The shape of the breast may also be distorted by leaving all the pectoralis muscle fibers intact. For this reason, most surgeons will divide the lower muscle border so the implant “settles” nicely into a natural position and movement with muscle flexion is minimized.

Many surgeons including Dr. Short do not believe that breast implants placed in the subglandular position will be more likely to sag. Dr. Short feels that the capsule which the body naturally forms around the implant holds the implants in position and that sagging has more to do with the woman’s natural skin elasticity and stretch capacity and the size of the implants than the pocket in which the implant is placed.

Dual plane breast implant placement – Dr. Short feels that woman with some natural sagging or relaxation of the tissues of the breast prior to breast augmentation surgery often need a dual plane approach. She divides the layers between the muscle and breast tissue while still placing the implant beneath the muscle so that the tissues “wrap around” the implant and look natural. Otherwise, if the breast tissue is left fully attached to the muscle, it can tend to “droop” over the muscle and the implant giving a funny looking shape to the breast. Clearly, each woman should have a customized breast augmentation plan specifically designed to fit her needs.