There are pros and cons to both approaches. Dr. Payne usually puts implants under the muscle for several reasons. First, implants placed under the muscle feel more natural than those placed on top of the muscle. In patients with thin skin and breast tissue implants placed on top of the muscle can more easily be seen and felt through the skin which is unnatural. They also are more likely to cause visible rippling of the breast which most patients very much do not like. Second, Dr. Payne believes that the risk of capsular contracture is lower when the implants are placed under the muscle. Capsular contracture is a condition where scar tissue forms around the implant and then tightens. As the scar tissue tightens the breast becomes firm and unnaturally round and tends to ride higher up on the chest causing noticeable asymmetry between the two breasts. Third, Dr. Payne believes that implants placed under the muscle look softer and more natural than implants placed on top of the muscle. Fourth, Dr. Payne believes that when mammograms are performed looking to detect breast cancer that it is easier for the radiologist to read the mammograms when the implants are placed under the muscle. This means a patient could have a breast cancer with microcalcifications and the implant on top of the muscle might make it harder for the radiologist to see these than if the implant had been put under the muscle.
Dr. Payne believes that the three main advantages of implants placed on top of the muscle is that for the first few days after surgery the patient has less pain than if the implants had gone under the muscle. If patients take the medication they are given after surgery this usually doesn’t make much difference one way or the other. Most patients are fairly comfortable following a breast augmentation operation within 3-5 days after surgery. A second reason is that implants placed on top of the muscle look more “fake” which is something that some women like. Remember that as time passes the breast fat and tissue will thin out and that an implant placed on top of the muscle might look good for a while but then some years later it might start to ripple and look bad. A third reason to go on top of the muscle is that if a woman is an athlete who competes in various activities where the arms are used (e.g. golf or tennis) it is possible that implants placed under the muscle might interfere with her athletic abilities whereas an implant placed on top of the muscle might be less likely to do this.