Putting an implant under the muscle requires an incision into the pectoralis muscle . It also requires to dissect a space between the small and large pectoralis.
This incision and the dissection do generally provoke more bleeding than a subglandular dissection.The resulting bleeding and the subsequent collection of old blood is responsible for more and not less capsular fibrosis with this approach.
Statistically about 60 % of surgeons put the implant above the muscle, 40 % below.
In case of an augmentation, implants should always be placed above the muscle. This is the most natural location. The implants move with one's own gland, in a natural way. On the other hand,there is no chemical or physical interaction with the breast whatsoever, they sit behind a solid sheet of connective tissue .There is no interference with the physiology : patients can breast feed without any problems.
Some surgeons still place implants on a deeper, submuscular level.
They do this in order to:
Masking the dimple of the upper pole gives good results. Nevertheless the risk of developing more capsular fibrosis than with a submammary placement is high :
Old blood remaining around the implant is the main trigger for pathological scar formation called capsular fibrosis. Therefore,every precaution should be taken to prevent bleeding.
I always rinse the area around the implants with a saline solution until all the blood is gone. When necessary, drains are also placed to drain the last droplets.
Since we apply this technique by routine, the incidence of capsular fibrosis dropped from an average of 7% to less than 1%.i haven't seen any capsular fibrosis for the last 6 years.