There are four locations or pockets which are made and where the implant may be placed during this cosmetic surgery; 1. Directly under the breast tissue, or the subglandular (in front of the pectoralis muscle), 2. the subfascial(behind the breast tissue but in front of the muscle in a space developed by lifting the front lining of the pectoralis muscle-the fascia) , 3. the submuscular (behind the pectoralis muscle) and 4. the dual plane position(partly under the muscle and partly under the breast or fascia). The pectoralis muscle is the chest muscle that is commonly developed in body builders. Mr. Solomos positions the implants behind the muscle(submuscular) in approximately 50% of his patients and the remaining 50% under the fascia(subfascial) or breast tissue (subglandular). In the submuscular placement the implants are placed between the muscles of the chest wall and the rib cage. The advantage of submuscular placement is that it increases the padding overlying the implant offering more coverage and camouflage to the shape and outline of the implant. This is particularly helpful in women bearing very little or no breast tissue at all. By providing this extra padding in these circumstances, one then substantially decreases some of the adverse effects on the appearance mentioned above. Another advantage is that mammography has been reported to be slightly more effective. The Disadvantages are that there may be a bit more pain, or discomfort, after plastic surgery, the breast feels slightly firmer than when the implant is placed in front of the muscle, and that the breast will move with certain actions of the muscle. In the subfascial or subglandular placements, the advantage is that there is usually less pain after the operation, and that the breasts usually feel slightly softer. The disadvantage is that the outline of the implant may be more prominent or visible in very slim women. In these situations one can therefore sometimes detect a “step-off” appearance or “stuck-on” look of the breasts on the chest. In these situations you will be advised to have the implant placed submuscularly. There are however some breast shapes that are better suited to the subglandular approach. These women typically have breasts that at one time were much larger than the present. When there is a very large volume decrease and there is little or no shrinkage in the size of the skin envelope surrounding the breast tissue, then the shape approaches that of an “empty bag”. Under these circumstances it is sometimes better to place the implant in the subglandular position in order to allow the implant to fill out the skin envelope of the breast. However in most of these circumstances, a simultaneous breast uplift or mastopexy is usually recommended to give the optimum result(see above). In this event, as well as when the skin envelope has stretched to the point where the nipple is below the breast fold, it will be necessary to reposition the nipple upward again and reduce the size of the skin envelope by means of an uplift or mastopexy. Again, this will be determined at the time of the consultation. (Please see breast uplift section) The decision, as to which location the implant should be placed in your case, will be discussed at the time of the consultation. Mr. Solomos’s primary concern is to give you as NATURAL a look as possible!