Reconstruction Over Or Under the Muscle ??

Up until fairly recently, it's pretty much always been done under the muscle. The muscle helps to hold the implant and gives a smoother appearance when there is no breast tissue between the chest wall and the skin. Some women complain about problems with the muscle function after surgery, being that it's somewhat distorted. Some complain about how the breast looks when they use the chest muscle.

A number of PS are now placing the implants above the muscle - where the breast tissue has been removed. It's a more natural position but has some drawbacks. Without any muscle over it, the upper poles can look more obviously like implants with a sharper step off. You can also be more likely to need fat grafting to add coverage. And the implant needs to be attached with Alloderm or a like product - kind of like an internal bra - to keep it from migrating.

Having implants above the muscle (pre-pec) and when done at the time of MX saves you from needing TE's and therefore another surgery to replace those with implants. Not everyone can have it done. You need to have skin that will accommodate the implant so it works best for women who want to stay about the same size or go smaller.

Not all PS are embracing this newer method. There's a thread on here that deals specifically with this topic and has a list of a number of PS that do it. I'll try to find it.

I was told by my PS that he would place my tissue expanders above the muscle. I was an A cup and wanted to go a little bigger. When I woke up from surgery though they told me they had to go under the pecs because there just wasn't enough skin. I was completely bummed and so sore. I wish I would've known that was a possibility that there was a chance it would have to be sub pectoral. All in all though, I'm about 7 weeks out, and it's not terrible. Just sore with each TE expansion.