fb Breast prosthesis: in front of or behind the muscle?
Dr Jérémy Djian, 5 Square Thiers , 75016
Surgery

Breast implants in front of or behind the muscle: which solution should you choose?

Published and scientifically verified by Dr Djian on 17/03/2025
Breast implant in front of or behind the muscle: which solution to choose?
Summary
  • POSITIONNEMENT PRÉ-MUSCULAIRE (DEVANT LE MUSCLE)
  • POSITIONNEMENT RETRO-MUSCULAIRE (DERRIÈRE LE MUSCLE)
  • POSITIONING RISKS AND COMPLICATIONS
  • CHOICE OF POSITIONING ACCORDING TO ANATOMY AND PERSONAL PREFERENCES
  • PSYCHOLOGICAL AND AESTHETIC FACTORS
  • POSITIONING TECHNIQUES EVOLVE WITH NEW TECHNOLOGIES
  • CONCLUSION AND ADVICE ON POSITIONING
In short
  • The choice between breast prosthesis in front of or behind the muscle has a direct influence on aesthetics, postoperative pain and long-term stability.
  • The pre-muscular positioning (in front of the muscle) is faster, less painful and corrects slight ptosis, but it is more exposed to risk of capsular contracture and a less natural result in slim patients.
  • The retro-muscular positioning (behind the muscle) offers a more natural look and reduces complications, at the cost of a longer recovery time and possible discomfort for sportswomen.
  • The new techniques as the dual-plan allow you to precisely adapt the fitting to your morphology and expectations.
  • The Dr Jérémy Djian helps every patient choose the right best customized option, The choice is yours, depending on your anatomy, lifestyle and aesthetic goals.

Comprendre le positionnement des prothèses mammaires par rapport au muscle pectoral est clé dans le cadre d’une chirurgie d’breast augmentation in Paris. It influences appearance, safety and long-term aesthetic results. The choice of breast prosthesis positioning, whether it be pre-muscular (in front of the muscle) or retro-muscular (behind the muscle), has a direct impact on the final outcome of the operation. So where should the breast prosthesis be placed, in front of or behind the muscle?

 

POSITIONNEMENT PRÉ-MUSCULAIRE (DEVANT LE MUSCLE)

 

Pre-muscular positioning involves placing the implant directly behind the mammary gland, with several advantages and disadvantages.

 

Breast implant position

Schéma de pose de la prothèse

 

ADVANTAGES

 

  • Faster, less painful surgery: being Because the implant is placed above the muscle, surgery is generally less invasive, reducing operating time and post-operative pain.
  • Stability of prostheses during muscle contraction: the implants do not move when the pectoral muscles contract, offering a feeling of stability.
  • Possible correction of slight breast ptosis: this positioning can also help to correct slight drooping of the breasts, providing a lifting effect.

 

DISADVANTAGES

 

  • Increased risk of capsular contracture: this This phenomenon occurs when scar tissue forms around the implant, which can make the breast hard and painful.
  • Less natural results in slim patients or in cases of weight loss: the contours of the implant may be more visible if the patient does not have sufficient breast tissue to camouflage the implant.

 

POSITIONNEMENT RETRO-MUSCULAIRE (DERRIÈRE LE MUSCLE)

 

Positioning retro-muscular involves placing the implant behind the pectoral muscle. This approach also has its advantages and disadvantages.

 

ADVANTAGES

 

  • More natural appearance: the The pectoral muscle helps mask the implant's contours, giving the breasts a more natural appearance.
  • Reducing the risk of capsular contracture: the studies show that the risk of developing capsular contracture is generally lower with this technique.
  • Better concealed implant contours: the muscle provides additional coverage, making the edges of the implant less visible.

 

DISADVANTAGES

 

  • Longer and potentially more painful procedure: the manipulation of the muscle makes surgery more complex and can result in greater post-operative pain.
  • Less suitable for very athletic patients: for For those who engage in strenuous physical activity, this positioning may be less comfortable due to the pressure exerted on the muscles.

 

What if the lack of tissue were compensated for in a way other than by the implant's position?
For patients whose breast tissue is too thin to properly conceal the implant—whether it is placed in front of or behind the muscle—Dr. Djian may offer an alternative: the’composite breast augmentation. This technique combines the Implant placement and autologous fat injection (harvested from the abdomen or thighs) in a single procedure. Lipofilling envelops the upper pole of the implant and smooths the transition with the surrounding tissue, making the edges of the implant imperceptible.

 

POSITIONING RISKS AND COMPLICATIONS

 

Like all surgical procedures, breast augmentation with implants carries its own risks. Complications may be general or specific to the positioning chosen.

 

COMPLICATIONS GÉNÉRALES

 

General complications related to breast augmentation include :

  • Capsular contracture : la formation d’une coque autour de l’implant qui peut provoquer une douleur et une déformation.
  • Implant rupture This can occur with any type of implant, requiring urgent surgical intervention.
  • Post-operative bleeding Hematomas may form, sometimes requiring surgical evacuation.

 

COMPLICATIONS SPÉCIFIQUES AU POSITIONNEMENT

 

The choice of positioning can influence these risks. For example, pre-muscular positioning can sometimes increase the risk of capsular contracture, compared with retro-muscular positioning where the implants are better protected by the muscle.

 

PRÉVENTION DES COMPLICATIONS

 

Pour éviter et minimiser les complications associées à une augmentation mammaire, il est essentiel de maintenir l’implant en place, soit par des bandes utilisées pour stabiliser l’implant pendant la période de guérison, soit en utilisant un soutien-gorge postopératoire spécialement conçu pour maintenir les implants en position et réduire le mouvement pendant la phase de convalescence. Le Dr Djian conseillera la meilleure méthode à adopter.

 

CHOICE OF POSITIONING ACCORDING TO ANATOMY AND PERSONAL PREFERENCES

 

The choice of breast prosthesis positioning must also take into account individual anatomical features and personal preferences.

 

INFLUENCE OF ANATOMY

 

The amount of existing breast tissue, skin quality and age play a crucial role in the choice of positioning. For example:

  • Patients with a good amount of breast tissue can benefit from pre-muscular positioning.
  • On the other hand, those with little tissue (such as an A or lower cup) may prefer a retro-muscular positioning to obtain a satisfactory aesthetic result.

 

INFLUENCE DES ACTIVITÉS PHYSIQUES

 

Regular sports activities can also lead to the choice of retro-muscular positioning. This minimizes the risks associated with muscle contraction during exercise, ensuring greater implant stability.

 

PSYCHOLOGICAL AND AESTHETIC FACTORS

 

Personal expectations play an important role in the decision to position prostheses.

 

PRÉFÉRENCES PERSONNELLES

 

Aesthetic expectations vary from patient to patient. Some women prefer a more natural look, and therefore more often choose a retro-muscular positioning. Others may prefer a less invasive procedure and opt for premuscular positioning. In all cases’opinion of surgeon Dr Djian is a determining factor in the final choice. Don't hesitate to tell him about your constraints.

 

CONSIDÉRATIONS SPÉCIFIQUES POUR LES PATIENTS AYANT DES IMPLANTS EXISTANTS

 

For patients considering new implants after having already undergone breast augmentation, it's essential to assess how to adapt positioning to suit existing prostheses. Here too, Dr. Djian will help you define the best approach after a thorough consultation.

 

POSITIONING TECHNIQUES EVOLVE WITH NEW TECHNOLOGIES

 

Technological advances have considerably improved surgical techniques for positioning breast prostheses, enabling more precise, natural-looking results. Two key innovations are 3D imaging and the dual-plane technique.

 

USING 3D IMAGING

 

New technologies such as 3D imaging make it possible to accurately assess the patient's morphology prior to surgery. This helps determine the best positioning to achieve an optimal aesthetic result while minimizing risks.

 

HYBRID TECHNIQUES SUCH AS DUAL-PLAN

 

The dual-plan method combines the advantages of pre-muscular and retro-muscular positions. It provides adequate coverage while maintaining flexibility of muscle movement. This technique is particularly beneficial for patients seeking to combine aesthetics with post-operative comfort.

 

COMPARAISON DES RÉSULTATS ESTHÉTIQUES À LONG TERME

 

Comparative studies show that each technique has its own long-term aesthetic results. The choice between a breast prosthesis in front of or behind the muscle must therefore take into account not only the immediate results, but also the long-term effects on the figure.

In front of or behind the muscle

Implant in front of or behind the muscle

 

CONCLUSION AND ADVICE ON POSITIONING

 

It is essential to address the choice of the position of breast implants with care and thought. An in-depth consultation with the Dr. Djian, experienced plastic surgeon in Paris, vous permettra d’évaluer toutes ces considérations afin de vous assurer de faire le bon choix. Prendre en compte non seulement les facteurs médicaux, mais aussi les facteurs personnels, garantira un résultat optimal tant sur le plan esthétique à moyen et long terme que sur le plan fonctionnel.

Your Questions

FREQUENTLY ASKED QUESTIONS ABOUT BREAST IMPLANTS

DO IMPLANTS BEHIND THE MUSCLE HURT MORE AFTER SURGERY?

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Yes, retro-muscular positioning often leads to more post-operative pain because the muscle is lifted to place the prosthesis. This discomfort is temporary and well controlled by painkillers. On the other hand, this technique offers more natural results in slim patients, with a reduced risk of blistering.

CAN THE POSITIONING OF AN EXISTING PROSTHESIS BE CHANGED?

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Yes, when changing implants, it is possible to modify their positioning according to the evolution of the skin., The technique can be adapted to the patient's specific needs, desired volume or discomfort. Dr. Djian reassesses each case in consultation to adapt the technique to the current anatomy and avoid complications.

IS THERE A VISUAL DIFFERENCE BETWEEN THE TWO TECHNIQUES?

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Yes, visual rendering is often more natural when the prosthesis is placed behind the muscle, especially if the patient has little breast tissue. In front of the muscle, the result may appear rounder or tighter, particularly when lying down or when the pectoral muscle is contracted.

WHAT POSITIONING IS RECOMMENDED AFTER MAJOR WEIGHT LOSS?

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After weight loss, the skin is often slackened and the breast tissue depleted: positioning is essential. behind the muscle or technical dual plan is then preferred for avoid visible creases and ensure better wear over time. Dr. Djian adapts the strategy to each individual case.

DOES POSITIONING INFLUENCE LONG-TERM STABILITY?

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Yes, prostheses placed in front of the muscle are sometimes more prone to descent over time, especially in cases of thin skin or sagging. Retro-muscular placement often offers better support and limits the effects of gravity over several years.

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Dr. Jérémy Djian
Dr. Jérémy Djian

Dr Jérémy Djian is a plastic surgeon based at 5 square Thiers, near the Victor Hugo roundabout, in the 16th arrondissement of Paris.

He trained in Paris and worked on the team of Professor Laurent Lantieri, a leading authority on face transplant surgery.

 

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