How Breast Implant Placement Has Changed Over the Years
Breast implant placement has changed significantly over the years as implant technology has improved. Techniques that were once considered standard were largely based on the limitations of older implant designs rather than what was most anatomically appropriate for patients.
In this video, Dr. Dimitri Koumanis explains how implant placement has evolved, why subfascial placement is now commonly used, and how modern cohesive implants allow for more natural results and easier recovery. He also discusses why placement decisions should be individualized rather than based on outdated standards. The full video transcription is included below.
Video Transcription
Historically, placing breast implants under the muscle was very common, especially when implants were less cohesive. Surgeons relied on muscle coverage to soften the upper breast, reduce visible implant edges, and lower the risk of rippling in thinner patients. At the time, this approach made sense based on the implant technology available.
However, implant technology has evolved dramatically. Modern cohesive implants provide improved structure and shape, which means we no longer need to rely on the muscle to disguise the implant in most patients. This advancement has allowed us to move toward more anatomically appropriate placement.
In our practice, we now rarely place implants under the muscle. Instead, we most often use a subfascial placement, where the implant sits over the muscle but beneath the muscle’s natural fascial layer. This approach provides coverage and support while allowing the implant to sit in a more natural position on the chest.
One of the biggest advantages patients notice is recovery. When implants are placed under the muscle, the muscle must be stretched and manipulated, which can significantly increase post-operative pain. With subfascial placement, the muscle is left undisturbed, leading to less discomfort, faster recovery, and a quicker return to normal activity.
Subfascial placement also results in more natural movement and appearance. Implants placed under the muscle can sometimes cause unnatural breast movement when the chest muscles contract, known as implant animation. Because subfascial implants sit over the muscle, this animation does not occur. The breast moves naturally at rest and during activity, which is especially important for athletic or active patients.
With cohesive implants and subfascial placement, the breast often looks and feels more natural, particularly in the lower pole and central breast. The implant is not distorted by muscle movement, allowing the breast to settle into a more natural shape over time.
That said, implant placement is always individualized. There is no single option that is right for everyone. Factors such as anatomy, tissue thickness, aesthetic goals, and prior surgery all play an important role. The key is choosing an approach that aligns with today’s implant technology and your individual body, rather than relying on outdated standards.
Ultimately, the decision between over versus under the muscle is not about trends—it’s about evolution. With modern cohesive implants, subfascial placement often provides a more natural look, less pain, faster recovery, and eliminates animation issues.
If you’re considering breast augmentation and want a thoughtful, up-to-date approach, schedule a consultation with us at Saratoga Springs Plastic Surgery. I’m Dr. Dimitri Koumanis, and we’ll help you choose the placement that’s right for you.
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