Most patients get a dual plane, partly under the pectoral muscle — but thin tissue, mild sagging and how hard you train all move the answer.
For most patients the implant goes partly under the pectoralis muscle, in what is called a dual plane. The muscle gives extra soft tissue cover over the upper edge, which is the part of the implant that shows first in a thin chest, and it lowers the reported rate of capsular contracture. It also makes mammograms easier to read later. The trade-off is a slower, more uncomfortable first week and a temporary distortion when you flex the muscle hard.
Placing the implant under the gland only, in front of the muscle, suits women who already have enough of their own tissue — a pinch above two and a half centimetres — and women with mild sagging where the implant needs to sit slightly lower to fill loose skin. Recovery is faster and there is no animation distortion, which matters to competitive athletes and to anyone whose chest is on display when they train.
Under the muscle, contracting the pectoralis squeezes the implant and the breast moves or flattens briefly. In everyday life almost nobody notices it; in a gym mirror, a photograph mid-press or on stage, some women find it genuinely irritating. It cannot be fully removed by technique, only reduced by how the muscle is released at the lower border. If this is a serious concern for you, say so at the consultation, because it changes the plane we recommend.
The plane is chosen from the pinch test, the amount of skin laxity and what you do with your body, not from a preference stated in a message before anyone has examined you. Breast aesthetics starts at €3,500 and the price does not change with the pocket, so there is no commercial reason to steer you either way. We write the recommendation down before you fly, and the surgeon confirms it on the table with the tissue in front of him.
The plane is not the issue; the incision is. Milk ducts and nerves run behind the areola, so an incision in the fold under the breast interferes least. Most women with implants placed through that route breastfeed normally, and we choose it by default in women who may want to.
Yes, and it is a recognised revision when rippling or a visible edge appears years later. The old capsule is dealt with and a new pocket made under the muscle in the same operation. It is more complex than the first surgery, which is why the plane is worth getting right initially.