Dr Kumar places implants under the muscle for most patients, usually as a dual plane. The one exception in his practice is the Preservé technique, which places the implant above the muscle and is only possible with the specific equipment, technique and implant type it requires.
Placement is not a matter of fashion. It is decided by how much of your own tissue is available to cover the implant, and by what you want the breast to do when you use your chest.
The three positions
| Position | Where the implant sits | Suited to |
|---|---|---|
| Subglandular (over the muscle) | Behind the breast, in front of the pectoral muscle | Patients with good soft tissue cover; avoids animation |
| Dual plane | Upper part behind the muscle, lower part behind the breast | Most patients; combines cover above with a natural lower pole |
| Full submuscular | Entirely behind the muscle | Very thin cover; less commonly used in cosmetic augmentation |
What each position trades
Under the muscle gives more tissue over the top edge of the implant, so the upper border is less visible and rippling is less likely in thin patients. The trade is a longer, more uncomfortable first week, and animation deformity — movement or flattening of the breast when the chest muscle contracts. For most patients that is only apparent in specific positions; for a competitive weightlifter or a professional dancer it can matter a great deal.
Over the muscle avoids animation entirely and is usually more comfortable early on. The trade is that the implant relies on your own breast tissue for cover, so where that tissue is thin the upper edge and any rippling show more readily, and the weight of the implant sits directly on skin that has to hold it.
Dual plane is the middle position and the reason it is used most: cover where it is needed at the top, and the implant able to fill the lower pole naturally.
The measurement that usually settles it
A pinch of the tissue at the upper pole of the breast tells you how much cover you have. Below roughly two centimetres of pinch thickness, most surgeons will want muscle over the implant. Above it, more options are genuinely open. This is measured at your consultation, not estimated from photographs.
Does placement affect anything else?
- Mammograms. Implants obscure some breast tissue whichever plane they sit in. Tell the radiographer you have implants so the appropriate views are taken.
- Capsular contracture. Placement is one of several factors discussed in the literature; it is not the whole story. See capsular contracture.
- Breastfeeding. Neither plane removes glandular tissue, so neither is expected to prevent feeding, though no surgeon can promise it will be unaffected.
- Revision. Changing plane later is possible but is a bigger operation than the first one.
Where the incision goes
Dr Kumar uses an incision in the inframammary fold. Other sites exist — around the areola and through the armpit — and each has advantages; the fold incision gives direct access for accurate pocket creation and places the scar where a bra or swimwear covers it.
Common questions
Is under the muscle more painful? The first week generally is, because the muscle has been lifted. Most patients are comfortable well before the six-week review. Recovery week by week.
Will my breasts move at the gym? With an implant under the muscle, contracting the chest can move or flatten the breast. It is worth raising at consultation if you train seriously.
Which lasts longer? Neither has a fixed lifespan. Cover matters more than plane for how the breast looks in ten years.
What is the Preservé technique? A specific above-the-muscle approach Dr Kumar is formally trained in. Read about it here.
Next step
Placement is decided by examination and measurement. Bring a GP referral — it is required to see Dr Kumar. Call 1300 267 726 or request a call from his nursing team. More about breast augmentation, implant size and implant types.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
