The implant in front of the muscle at a glance
- PositionUnder the breast gland, in front of the muscle
- AdvantageImplant that moves with the breast
- RecoveryLess painful
- LimitationInsufficient coverage in a slim patient
- IndicationSufficient tissue, small implant
- Price€5,000 to €10,000
In a prepectoral breast augmentation, known as “in front of the muscle” or subglandular, the implant is placed directly under the breast gland, in front of the pectoralis major muscle. It moves naturally with the breast, the skin and breast tissue drape well over it, and recovery is less painful. On the other hand, it is less well covered: in a slim patient, its edges and rippling may show in the cleavage, and the breast tends to sag more over time. It is best suited to cases where the tissues are sufficient and the implant is small.
Price: breast augmentation €5,000 to €10,000, implants included, on a written quote after a consultation (€100).
Where is the implant placed?
The implant is placed between the breast gland and the pectoralis major muscle. This is the most logical position: the implant and the breast form a single unit, which explains its main advantages. It is covered only by the breast gland, fat and skin, which explains its limitations in slim patients.
In front of the muscle, behind the muscle or dual plane: what is the difference?
| In front of the muscle (prepectoral) | Behind the muscle (classic subpectoral) | Dual plane | |
|---|---|---|---|
| Implant position | Under the breast gland, in front of the muscle | Upper and inner parts under the muscle | Upper part under the muscle, lower part under the gland |
| Implant disguised in the cleavage | Less well in a slim patient | Yes | Yes |
| Capsular contracture | More frequent | Less frequent | Less frequent |
| Movement when the muscle contracts | No, the implant moves with the breast | Yes | Reduced |
| Recovery | Less painful | More painful, later return to activity | Drawbacks of the subpectoral position reduced |
| Long-term sagging of the breast | More frequent | Less frequent | Less frequent |
| Best indication | Sufficient tissue, slight ptosis, small-volume implant | Insufficient coverage: slim patient, juvenile breast | Most augmentations |
In front of the muscle: the implant is under the gland, in front of the pectoralis major muscle.
- 1Implant
- 2Pectoralis major muscle
- 3Breast gland
- 4Ribs
What are the advantages of the position in front of the muscle?
- An implant that moves with the breast. Placed directly under the breast gland, it naturally follows the movements of the breast and does not move when the muscle contracts.
- Good draping of the breast. The skin and breast tissue spread out evenly over the implant, which corrects a slightly sagging breast better in the short term.
- A less painful recovery and a faster return to normal activity than with an implant behind the muscle.
The dual plane offers the same draping advantages, while disguising the upper part of the implant under the muscle.
What are its drawbacks?
- A less well-covered implant. The upper and inner parts of the implant are covered only by the breast gland and skin: in a slim patient, rippling may appear in the cleavage and the edges of the implant may show.
- Thinning of the tissues over time (tissue attenuation): the layer covering the implant gradually becomes thinner, with a risk of rippling and of an implant that can be felt to the touch years after the operation.
- More sagging of the breast (ptosis) in the medium and long term than with an implant behind the muscle.
- A rate of capsular contracture that is thought to be higher than behind the muscle, although this is debated.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and can even eliminate some of them.
Who is the position in front of the muscle suited to?
According to Dr Médard de Chardon’s research (2008 thesis), the best indication combines three conditions:
- sufficient tissue (breast gland, fat and skin) to disguise the implant;
- slight ptosis (grade I: breast slightly sagging, nipple level with the fold under the breast), which allows the breast to drape well over the implant;
- a small-volume implant.
When should it be avoided? The position in front of the muscle should not be used in a slim patient with thin tissues, especially with a large-volume implant: the implant is likely to be visible and palpable. The position behind the muscle or the dual plane is then preferable.
Thick tissues: the gland, fat and skin disguise the implant; the position in front of the muscle is possible.
- 1Implant
- 2Pectoralis major muscle
- 3Breast gland
- 4Ribs
- 5Edge of the implant and rippling visible in the cleavage
Dr Médard de Chardon’s experience
- MD thesis on breast augmentation with implants, defended at the Nice Faculty of Medicine in 2008: the indications above are drawn from it.
- More than 3,000 breast implants placed; practising in Cannes since 2011.
- Qualified plastic surgeon in plastic, reconstructive and aesthetic surgery, former Chef de Clinique (university hospital senior registrar), Nice Faculty of Medicine; member of SOFCEP (French Society of Aesthetic Plastic Surgery), SOFCPRE (French Society of Plastic, Reconstructive and Aesthetic Surgery) and ISAPS (International Society of Aesthetic Plastic Surgery).
How does breast augmentation work?
The position of the implant (in front of the muscle, behind the muscle or dual plane), its shape, its volume and the scar are chosen in consultation, after trial sizers and a 3D simulation. The operation lasts about 1 hour, as day surgery or with a one-night stay at Clinique Oxford in Cannes; time off work is 7 to 10 days. The process, recovery and risks are set out on the breast augmentation page. See also: round implants, anatomical implants.
See before and after breast augmentation photos
Frequently asked questions about the implant in front of the muscle
Breast implant in front of or behind the muscle: which should you choose?
It all depends on the thickness of the tissues covering the implant. When the tissues are sufficient and the implant small, the position in front of the muscle is possible; in a slim patient, the position behind the muscle disguises the implant better. Dr Médard de Chardon most often uses the dual plane, which combines the advantages of both.
Is placing a breast implant in front of the muscle less painful?
Yes. The muscle is not lifted: recovery is less painful and the return to normal activity faster than with an implant behind the muscle.
Is a breast implant in front of the muscle more visible?
In a slim patient with thin tissues, yes: the edges of the implant and rippling may show in the cleavage, especially with a large volume. The tissues covering it may also thin over the years.
Does placing the implant in front of the muscle make the breasts sag?
In the short term, the skin and breast tissue drape very well over the implant. In the medium and long term, however, the breast tends to sag more than with an implant behind the muscle.
Is the risk of capsular contracture higher with an implant in front of the muscle?
Capsular contracture is thought to be more frequent than behind the muscle, but this is debated. The choice of position rests mainly on the thickness of the tissues and the volume of the implant.
Does the dual plane have the same advantages as the position in front of the muscle?
Yes, as far as draping is concerned: in the dual plane, the lower part of the implant is placed under the breast gland, as in front of the muscle, while the upper part remains disguised under the muscle. It is the position Dr Médard de Chardon chooses in most cases.
References
This information is drawn from Dr Victor Médard de Chardon’s MD thesis on breast augmentation with implants (Nice Faculty of Medicine, 2008).
- Cornette de Saint Cyr B, Delmar H, Aharoni C. Approach to augmentation mammaplasty. Ann Chir Plast Esthet 2005; 50: 451-462.
- Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2001; 107: 1255-1272.
- Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg 2002; 109: 1396-1409.
- Biggs TM, Yarish RS. Augmentation mammaplasty: a comparative analysis. Plast Reconstr Surg 1990; 85: 368-372.
- Hidalgo DA. Breast augmentation: choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg 2000; 105: 2202-2216.