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Breast Implant Placement Above or Beneath the Chest Muscles

This article discusses breast augmentation top surgery, formerly known as MTF top surgery or MTF breast augmentation, and the different surgical placements for your breast implants. We provide information on the risks and benefits of subglandular and submuscular placement including recovery, appearance, and potential complications. We hope this information can help in the decision making process for your gender confirmation surgery. It is important to note that it is best to consult with your surgeon to better assess your goals and needs.

If you’re considering breast augmentation, you’re probably wondering what your final outcome will look like. Many of our patients worry that their breast implants will not look right or like they have envisioned for themselves,  especially if they already possess naturally large pectoral (chest) muscles.

If this sounds like you, there are several surgical techniques that our surgeons can use to create a chest that meets your wants and needs. 

Choosing Breast Augmentation: Who is a Good Fit?

The goal of breast augmentation is to give you fuller, more conventionally feminine breasts. 

The Gender Confirmation Center uses an informed consent model to assess candidacy for all of our services. To determine if you are a good candidate for surgery, you will need to undergo a personal consultation with one of our surgeons. If moving forward with surgery, our surgeons will work with you to design a personalized treatment plan based on your goals and your body. 

Implant Placement: Above or Below the Chest Muscle

An important decision that you will need to make in advance of surgery is implant placement. Silicone breast implants can be placed above (subglandular) or below (submuscular) the chest muscle. If you have naturally large chest muscles, your surgeon may recommend that your implants be placed above them to conceal the muscular contours of your chest.

There are several advantages to subglandular placement, such as a shorter, less painful recovery period. Patients with subglandular placement also experience less implant movement during physical activity. However, it is important to note that your implants will be closer to the surface, which means that they will probably be more visible and more easily felt. Silicone implants are preferred for this placement because they offer a more “natural” appearance when compared to saline implants.

With submuscular placement, the implants are placed below the pectoral muscles and breast tissue. This placement often requires a more extensive recovery, but it offers patients a lower rate of capsular contracture (scar tissue forming around the implant), rippling (seeing the edges of the implants through the skin), and downward placement (malpositioning of the implants). It is important to carefully consider the advantages and disadvantages of each placement before making your final decision. Our surgeons will work with you to ensure the best outcome  possible is achieved.

Additional Options

If subglandular implant placement isn’t for you, there are other options that can minimize a naturally large chest. Our surgeons will be able to determine if certain surgical techniques such as “scoring” the chest muscles can create softer, lower breasts. The best way to determine which technique is right for you is to meet with one of our surgeons for a consultation.