Breast Implant Placement: Over, Under or Dual Plane?

Most people who come in for a breast augmentation consultation have already done a fair bit of homework. They’ve thought about size. Many have read up on silicone and saline breast implants. Very few have thought about where the implant will actually sit.

That’s worth fixing, because breast implant placement affects how the breast looks, how it moves when you exercise and how it changes over the years. In current Australian practice there are three main options. Which one suits you depends on your own anatomy, not on a general rule.

Below, we explain each option, the trade-offs involved and how a Specialist Plastic Surgeon decides what to recommend. Please keep in mind that this article is general information only. It doesn’t replace a personalised consultation, where your surgeon can examine you and talk through what may suit your body and goals.

The Three Main Breast Implant Placement Options

Think of the implant as sitting in a pocket. During breast augmentation, your surgeon creates that pocket at one of a few depths in the chest:

Subglandular (over the muscle): the implant sits behind the breast tissue, in front of the pectoralis major (the main chest muscle).
Submuscular or subpectoral (under the muscle): the implant sits behind the pectoralis major muscle.
Dual plane: the upper part of the implant sits under the muscle, while the lower part sits directly behind the breast tissue.

A fourth, less common option is subfascial placement. Here the implant goes under the thin sheet of connective tissue (fascia) that covers the chest muscle, but not under the muscle itself.

One thing trips a lot of people up. When surgeons say “under the muscle” in everyday conversation, they usually mean dual plane. The pectoral muscle doesn’t reach low enough to cover an implant completely, so the lower part of the implant normally sits behind breast tissue anyway.

Over the Muscle (Subglandular) Placement

With subglandular placement, the pocket is created between the breast tissue and the chest muscle. The muscle itself is left alone.

That brings some potential advantages. Because no muscle is released, the first few days of recovery are often more comfortable. There’s no animation deformity (more on that below), since the muscle never presses on the implant. Over the muscle breast implants may suit people who already have a good amount of breast tissue and soft tissue cover, and the option is sometimes considered where there is mild sagging.

There are trade-offs, though. If your tissue is thin, the implant edges and any rippling may be easier to see or feel, especially in the upper and inner breast. Published studies have generally reported higher rates of capsular contracture (scar tissue tightening around the implant) with subglandular placement than with under the muscle options. The evidence isn’t entirely consistent, and other factors play a part too.

Over the muscle implants also tend to hide more breast tissue on a mammogram. And over time, your skin and breast tissue carry the full weight of the implant on their own, which may influence how the breast changes with age.

Under the Muscle (Submuscular) Placement

Full submuscular placement means the implant sits entirely behind the chest muscle and, in some techniques, the neighbouring muscles as well. In cosmetic augmentation this is fairly uncommon today. You’re more likely to see it in breast reconstruction.

The main appeal is extra cover. The muscle adds a layer over the upper part of the implant, which may make edges and rippling less visible in slimmer patients. Under the muscle placement also tends to allow a clearer view of breast tissue on a mammogram, and many published studies have reported lower capsular contracture rates in this plane.

So, do implants under the muscle look more natural? For people with very little upper breast tissue, they often can, because the muscle softens the upper edge of the implant. For people with plenty of breast tissue, the difference may be much smaller.

The downsides mostly relate to the muscle. Recovery is usually more uncomfortable in the first week, and some people describe a tight, heavy ache across the chest. Early recovery may take a little longer. Animation deformity can also occur when the chest muscle contracts. For a general timeline, see our guide to breast augmentation recovery.

Dual Plane Placement

Dual plane is a hybrid of the two. Your surgeon releases part of the lower attachment of the pectoral muscle. The muscle then covers the upper portion of the implant, while the lower portion sits directly behind the breast tissue.

Early data from the Australian Breast Device Registry shows that placing the implant at least partly under the muscle is the most commonly recorded approach for cosmetic augmentation in Australia. The reasoning is fairly simple. The muscle helps camouflage the implant in the upper breast, where tissue is often thinnest. Meanwhile, the lower breast is free to expand over the implant, which tends to give the lower half a softer slope.

Dual plane breast augmentation isn’t one fixed technique. Surgeons describe several variations, depending on how much the muscle and breast tissue are separated from each other. The amount of release is decided during surgery, based on how your tissues respond. That flexibility is why dual plane may be useful where there’s mild sagging or a tight lower breast that needs more room to expand.

Placement Comparison at a Glance

The table below sums up the general differences. These are tendencies rather than rules, and your own situation will depend on your anatomy and your surgeon’s assessment.

Consideration	Over the muscle	Under the muscle	Dual plane
Upper breast camouflage	Least	Most	Good
Early recovery comfort	Generally easiest	Generally most uncomfortable	In between
Movement when the chest muscle contracts	None	Most likely	Possible, usually less noticeable
Reported capsular contracture rates	Generally reported as higher	Generally reported as lower	Generally reported as lower
Effect on mammogram views	Most interference	Least interference	Less interference
Often considered for	Patients with good soft tissue cover	Very thin tissue; more common in reconstruction	Many cosmetic augmentation patients

How Your Surgeon Chooses the Right Breast Implant Placement for You

Placement isn’t something you choose from a menu. It’s a surgical judgement, and it follows a careful examination. At consultation, Dr Grant Fraser-Kirk, Specialist Plastic Surgeon (MBBS, BSc (Biomed), PGDipSurgAnat, FRACS), will usually assess:

Soft tissue thickness in the upper breast. This is often the single biggest factor. If there’s very little tissue above the breast, the extra cover of dual plane or submuscular placement may help hide the implant edge.
Breast tissue volume. How much breast tissue you already have affects how well an implant can be covered.
Sagging and nipple position. Where the nipple sits in relation to the fold under the breast can influence the pocket. Sometimes it points towards a breast lift as well.
Chest wall shape. Rib shape, chest width and any asymmetry all feed into the plan.
Implant size and profile. A larger or more projecting implant generally needs more cover.
Your training and your job. If you work your chest hard at the gym or lift heavily at work, animation may matter more to you.
Pregnancy and breastfeeding plans. These are worth raising early, along with how your breasts may change afterwards.
Breast screening and family history. Your screening needs may affect which placement makes the most sense.

The final plan is confirmed at consultation, after examination and measurement. Dr Fraser-Kirk will explain the reasoning behind his recommendation, so you can understand why one option may suit you better than another. If you have some sagging, our article on breast lift with or without breast implants may also help.

Placement, Exercise and Animation Deformity

The name puts people off, but what happens is fairly simple. If the implant sits partly or fully under the pectoral muscle, the muscle presses on it each time it tightens. You might see the breast shift, change shape or flatten for a moment. Once the muscle relaxes, it goes back to how it was.

You won’t see it at rest. For many people it’s subtle and makes no real difference day to day. It may matter more if you do a lot of push-ups, bench presses or other chest work, or if your job involves heavy lifting.

That’s exactly the kind of detail to mention at your consultation. It’s far better to talk it through before surgery than to discover it afterwards.

Placement and Breast Screening

Does implant placement affect mammograms? It can. All breast implants hide some breast tissue on a mammogram, whatever the placement. If you have implants, tell the radiographer when you book and again on the day. They’ll usually take extra images called Eklund (implant displacement) views, where the implant is gently moved back so more breast tissue can be seen.

In general, implants placed under the muscle allow a better view of the breast tissue than implants placed over the muscle. Either way, keep up routine breast screening as recommended by your GP or BreastScreen Queensland. Having implants doesn’t change the need for regular checks.

Can Implant Placement Be Changed Later?

Yes. Moving an implant to a different pocket (for example, from subglandular to dual plane) is a type of revision surgery, sometimes called a site change. It’s a bigger operation than the original augmentation, with its own risks and recovery, so it isn’t a decision to take lightly.

This is one reason the first planning conversation matters so much. Breast implants aren’t lifetime devices, and further surgery may be needed at some point for a range of reasons.

Every Placement Carries Risks

No placement option removes the risks of breast augmentation. Possible complications include bleeding, infection, capsular contracture, implant rupture, changes in nipple or breast sensation, asymmetry and visible scarring. Breast implants have also been linked to rare conditions, including breast implant associated anaplastic large cell lymphoma (BIA-ALCL), a rare cancer of the immune system. The Therapeutic Goods Administration (TGA) publishes current safety information on breast implants.

Your surgeon will go through these risks with you in detail. You can also read about the risks and complications of surgery on our website.

Finding the Right Breast Implant Placement for You

There’s no single best breast implant placement. There’s only the placement that best fits your anatomy, your lifestyle and your goals. Reaching that decision is a shared process with your surgeon, made after a proper examination rather than picked from a list.

If you’re considering breast augmentation on the Sunshine Coast, the next step is a consultation. You’ll need a referral, usually from your GP, before your first appointment. Bring your questions, including any about exercise, screening or future pregnancy. To learn more about our approach to breast surgery, or to arrange a consultation, contact Fraser-Kirk Plastic Surgery at Level 3, 37 The Esplanade, Maroochydore QLD 4558, or call (07) 5438 3588.

Why Choose Dr Fraser-Kirk and Dr Sparks for Breast Augmentation on the Sunshine Coast

Breast augmentation at Fraser-Kirk Plastic Surgery is performed by Dr Grant Fraser-Kirk, a FRACS-qualified Specialist Plastic and Reconstructive Surgeon who consults in Maroochydore on the Sunshine Coast.

Dr Grant Fraser-Kirk (MBBS, BSc (Biomed), PGDipSurgAnat, FRACS) completed Bachelor degrees in Biomedical Science, Medicine and Surgery at the University of Queensland. He then completed four years of General Surgery training and a further five years on the Australian and New Zealand Plastic Surgery Training Program. In 2017 and 2018, he was selected for the Guy’s and St Thomas’ Trust Microvascular Reconstruction Fellowship in London, where he performed over 300 breast reconstructions. He has a particular interest in breast and skin reconstruction, microsurgery and orthoplastics.

He works alongside Dr David Sparks (MBBS (Hons), MS (Plast), PhD, FRACS (Plast)), an Australian-trained Specialist Plastic and Reconstructive Surgeon whose surgical focus is deep plane face and neck lift and facial surgery. Both surgeons hold AHPRA specialist registration in plastic surgery. You can read more about why it matters to see a Specialist Plastic Surgeon rather than a cosmetic surgeon.

Your consultation covers your medical history, goals, an examination, implant and placement options, and the risks and recovery involved. A referral, usually from your GP, is required before your first appointment. In line with Medical Board of Australia guidelines, you’ll have at least two pre-operative consultations and a cooling-off period of at least seven days after giving informed consent. There’s no obligation to proceed.

To book, contact Fraser-Kirk Plastic Surgery at Level 3, 37 The Esplanade, Maroochydore QLD 4558, or call (07) 5438 3588. Patients attend from across the Sunshine Coast, including Noosa, Caloundra and Gympie.

Frequently Asked Questions About Breast Implant Placement

Is it better to have breast implants over or under the muscle?

Neither breast implant placement is better for every patient. Under the muscle and dual plane placement usually give more cover over the upper implant and have generally been linked with lower capsular contracture rates. Over the muscle placement avoids animation deformity and is often more comfortable early on. A Specialist Plastic Surgeon recommends a placement after assessing soft tissue thickness, breast shape and lifestyle.

What is dual plane breast augmentation?

Dual plane breast augmentation places the upper part of the implant under the pectoral muscle and the lower part directly behind the breast tissue. Placement at least partly under the muscle is the most commonly recorded approach for cosmetic augmentation in Australian Breast Device Registry data. The amount of muscle release in dual plane breast augmentation is tailored to each patient during surgery.

Does breast implant placement affect mammograms?

Yes, breast implant placement can affect mammograms. All breast implants hide some breast tissue, and implants placed over the muscle usually hide more than implants placed under the muscle. Patients with breast implants should tell the radiographer, who will usually take extra Eklund displacement views. Routine breast screening should continue as recommended by a GP or BreastScreen.

Is recovery harder with implants under the muscle?

Usually, yes, at least in the first week or so. When the implant goes under the muscle, part of the pectoral muscle has to be released, so the chest tends to feel tighter and sorer early on. Your surgeon will give you a recovery plan that covers when you can get back to work, driving and exercise.

What is animation deformity after breast augmentation?

Animation deformity is a visible movement or flattening of the breast when the chest muscle contracts, seen with implants placed partly or fully under the muscle. Animation deformity appears only while the muscle is working, such as during a push-up, and the breast settles back at rest. Animation deformity is usually more noticeable in patients who train their chest heavily.

Medical References

Therapeutic Goods Administration (TGA). Breast implant hub. https://www.tga.gov.au/resources/explore-topic/breast-implant-hub
Australian Breast Device Registry (ABDR). General information for patients. https://abdr.org.au/patients/general-information-for-patients/
Vishwanath S, Pellegrini B, Parker E, et al. Breast device surgery in Australia: early results from the Australian Breast Device Registry. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2021. https://research.monash.edu/en/publications/breast-device-surgery-in-australia-early-results-from-the-austral/
Healthdirect Australia. Breast implants. https://www.healthdirect.gov.au/breast-implants
Australian Society of Plastic Surgeons. Breast augmentation. https://plasticsurgery.org.au/procedures/breast-augmentation/
Medical Board of Australia. Guidelines for medical practitioners who perform cosmetic medical and surgical procedures. https://www.medicalboard.gov.au/codes-guidelines-policies/cosmetic-medical-and-surgical-procedures-guidelines.aspx
Cleveland Clinic. Breast augmentation. https://my.clevelandclinic.org/cosmetic-plastic-surgery/procedures/breast-augmentation
Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plastic and Reconstructive Surgery. 2006;118(7 Suppl):81S-98S. https://pubmed.ncbi.nlm.nih.gov/17099485/
Shridharani SM, Bellamy JL, Mofid MM, Singh NK. Breast augmentation. Eplasty. 2013;13:ic46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685325/

Disclaimer: The information in this article is general in nature and is not a substitute for personalised medical advice. Individual results and recovery vary from person to person. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Breast Implant Placement: Over the Muscle, Under the Muscle or Dual Plane?