The Beauty Standard with Dr. Roy Kim

Breast Implant Placement Options Explained

• Dr. Roy Kim

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In this episode of The Beauty Standard, Dr. Roy Kim—board-certified plastic surgeon serving San Francisco and Beverly Hills—breaks down one of the most important yet often misunderstood decisions in breast augmentation: implant placement.

Are you curious about the difference between subglandular, subfascial, and dual plane placement? Wondering how each technique affects cleavage, recovery time, pain levels, and long-term results?

Dr. Kim discusses:

  • The pros and cons of each implant placement option
  • How your body type and lifestyle influence the best choice
  • The latest trends in plastic surgery, including why subfascial placement is on the rise
  • Important tips for active patients and what to avoid if you’re lifting or working out regularly

If you’re considering breast augmentation—or just want to stay informed—this episode will help you understand the what, why, and how behind the surgical decisions that lead to optimal results.

📅 Ready to take the next step? Book your consultation with Dr. Kim and find out what’s best for you.


#TheBeautyStandard #DrRoyKim #BreastImplants #BreastAugmentation #PlasticSurgeryPodcast #CosmeticSurgery #SubglandularPlacement #DualPlaneImplants #SubfascialPlacement #BreastSurgeryRecovery #PlasticSurgeonSanFrancisco #BeautyPodcast #BodyConfidence #BreastEnhancement

Thank you for tuning in to this week's episode of "The Beauty Standard" with Dr. Roy Kim! If you enjoyed this episode, please make sure to subscribe, rate, and leave us a review on your favorite podcast platform. Your support helps us continue to bring you the latest insights in aesthetic medicine and beauty trends.

Connect with us on social media on Instagram - @drroykim - or X - @drroykim- for more exclusive content, behind-the-scenes looks, and expert advice from Dr. Kim. Feel free to submit your questions or suggestions for future episodes – we'd love to hear from you!

Join us next week as we explore another fascinating topic in the world of beauty, and remember: your body, your choice, your standard!

Speaker 1:

Welcome to the Beauty Standard with Dr Roy Kim. Ever wondered about the different ways breast implants get placed and what that actually means for how things look and feel?

Speaker 2:

Yeah, it can definitely feel like you're wading through a lot of medical terms.

Speaker 1:

Totally so. In this deep dive, we're going to focus on breast implant placement Specifically. You know the differences between going above the muscle, below the muscle, and then there's this other one under the fascia.

Speaker 2:

Exactly. And to help us unpack all that, we've been looking at a video by Dr Roy Kim. He's a plastic surgeon and he does a really great job explaining the nuances.

Speaker 1:

He really does. So our mission here is pretty simple Break down the jargon, give you a clear picture of these different placement options.

Speaker 2:

Right, so you can feel informed, maybe empowered, whether you're actually considering this or just, you know, curious about it all.

Speaker 1:

Okay, let's dive in, starting with the first one above the muscle placement.

Speaker 2:

So above the muscle. Dr Kim also calls this sub glandular. Basically, the implant sits directly under the skin and the breast tissue itself.

Speaker 1:

So it's sitting right on top of the main chest muscle, the pectoralis, and it's covering the fascia.

Speaker 2:

That's the one.

Speaker 1:

And listening to Dr Kim, it sounds like this isn't really the go-to method anymore.

Speaker 2:

Yeah, he notes it's become less common. There are a few reasons why he mentions a higher chance of something called capsular contracture.

Speaker 1:

Okay, what's that exactly?

Speaker 2:

Well, because the implant is so close to the breast tissue and skin, the body's natural reaction creating scar tissue around something foreign could be a bit more aggressive sometimes.

Speaker 1:

Oh, so that's scar tissue tightening up.

Speaker 2:

Exactly that's the capsular contracture, and it can sometimes cause discomfort or make things feel well less natural. Dr Kim also points out a slightly higher infection risk with this placement.

Speaker 1:

Makes sense. Less natural padding if it's right under the skin, I guess.

Speaker 2:

Precisely. He really emphasizes that Without enough tissue coverage you know, skin, breast tissue, muscle the final look might not be quite what you want.

Speaker 1:

Okay, so that's above the muscle. Now let's talk about what most people probably think of under the muscle.

Speaker 2:

Right Under the muscle or subpectoral. But, like you said, it gets really interesting here the way Dr Kim breaks it down.

Speaker 1:

First, maybe a quick picture of the muscle itself, the pectoralis.

Speaker 2:

Good idea. So imagine this big fan-shaped muscle.

Speaker 1:

It starts up near your shoulder, kind of sweeps down across the chest your shoulder kind of sweeps down across the chest To the breastbone sternum in the middle, yeah, and then down towards the bottom of the rib cage, understanding where this muscle is and where it isn't is key, and that's the crucial bit, isn't it? It doesn't actually cover the whole side of the chest, especially out towards the armpit.

Speaker 2:

Exactly, there's very little or even no pec muscle out there near the underarm and that's why under the muscle is usually more accurately called dual plane Dual plane.

Speaker 1:

Okay, explain that.

Speaker 2:

So when the surgeon makes the pocket it is under the muscle in the upper part and more towards the middle of the breast.

Speaker 1:

Okay.

Speaker 2:

But then, as you go down and out, towards the side, towards the underarm, remember, the muscle thins out.

Speaker 1:

Right.

Speaker 2:

So out there. The implant is only covered by the soft tissue, the skin and the breast tissue itself. Ah, so it's like part under muscle, part not Pretty much Imagine the implant kind of tucked under the top and inner part of the pec muscle, but the lower outer part is just under the breast tissue and skin, two different layers or planes covering it.

Speaker 1:

Dual plane. Okay, that makes way more sense than just under the muscle. So what are the upsides of doing it this way, this dual plane method, according to Dr Kim?

Speaker 2:

Well, he points out some big advantages. Because you've got both muscle and soft tissue covering different parts, you generally get more tissue coverage overall. Which means, which often leads to a more natural look and feel. Plus, he mentions a lower risk of that capsular contracture we talked about earlier. That's a definite win for the long run.

Speaker 1:

And for the surgeon.

Speaker 2:

From their perspective, it allows for really precise creation of that pocket which helps control the final shape and where the implant sits.

Speaker 1:

Okay, sounds good, but there's usually a trade-off, isn't there? Did Dr Kim mention any downsides?

Speaker 2:

He did. The main one is pain after surgery.

Speaker 1:

More pain. Why do I?

Speaker 2:

Because you have to lift and stretch that pectoralis muscle to make space for the implant. That's stretching. That's often the main source of discomfort afterwards, more so than with other placements.

Speaker 1:

Ouch, okay, but despite that, it sounds like this dual plane is still the most common way it's done.

Speaker 2:

Oh, absolutely. Dr Kim states it's the most common placement worldwide right now. It's a technique that's taught widely. Surgeons have a lot of experience with it. So's a technique that's taught widely. Surgeons have a lot of experience with it.

Speaker 1:

So it's kind of the standard then.

Speaker 2:

You could say that it offers a pretty good balance. But interestingly, dr Kim also talks about another option, one that might tackle some issues like that post-op pain, that's the under the fascia or subfacial placement.

Speaker 1:

Okay, fascia, you mentioned that earlier. The muscles covering. Dr Kim had a good analogy, didn't he Like on meat?

Speaker 2:

He did right, Fascia. Think of it like a thin but pretty strong sheet of connective tissue. It wraps around muscles, keeps them organized, kind of like a natural stocking.

Speaker 1:

Like that silvery skin on a piece of meat you trim off.

Speaker 2:

Exactly like that. Every muscle has it. So for the pec muscle there's this fascia layer In subfascial placement. The implants goes under that thin fascial layer.

Speaker 1:

But above the actual muscle fibers.

Speaker 2:

Precisely so. The order is skin, then breast tissue, then the fascia, then the implant and finally the muscle underneath it all.

Speaker 1:

Okay, I think I've got the layers straight. So what are the benefits Dr Kim sees with this approach?

Speaker 2:

Quite a few, actually. He points out that, like dual plane, it avoids putting the implant right next to the breast tissue, which naturally has some bacteria.

Speaker 1:

Okay, that's good.

Speaker 2:

You also tend to get a really nice soft feel because the implant is still well covered by the breast tissue and that fascial leg.

Speaker 1:

And the big one, recovery.

Speaker 2:

Yes, Significantly, he says. Patients often have a quicker recovery with luck pain. Stretching the fascia apparently causes very little discomfort compared to stretching the whole muscle like in dual plane.

Speaker 1:

Wow OK, less pain, quicker recovery. Sounds really appealing. But again, any potential downsides?

Speaker 2:

Yeah, there's one potential issue he flags. It's similar to the concern with above the muscle placement.

Speaker 1:

Which is.

Speaker 2:

Not enough padding. If someone has very, very little natural breast tissue to begin with, just placing it under the fascia might not provide enough coverage over the implant for the best look and feel.

Speaker 1:

Right, you still need some natural tissue on top.

Speaker 2:

Exactly so, with these different options above dual plane, subfascial how does a surgeon, or how should you, think about which one is best? Dr Kim highlights some key things to consider.

Speaker 1:

Like what.

Speaker 2:

Well, activity level is a big one If you're very active, especially if you do things that really work the chest muscles, like weightlifting. He often prefers the subfascial placement. The idea is to avoid having the pec muscle constantly squeezing down hard on the implant.

Speaker 1:

Ah, because that could affect it over time, like move it or something.

Speaker 2:

Potentially impact its longevity or appearance. Yeah, Subfacial avoids that direct muscle interaction.

Speaker 1:

Makes total sense. If you're hitting the gym hard, what about just how things look and feel? Generally, aesthetics.

Speaker 2:

Super important. Obviously, dr Kim's general rule of thumb is the more natural padding you have over the implant, whether that's muscle, fascia, fat, your own breast tissue the more natural it's likely to look and feel.

Speaker 1:

Especially for people who are quite thin to start with Exactly If there's not much natural tissue.

Speaker 2:

Getting enough coverage is key.

Speaker 1:

And he mentioned a technique to help with that, didn't he?

Speaker 2:

If someone doesn't have much natural padding, yes, fat grafting taking fat from somewhere else on your body, say the tummy or thighs, and transferring it to the breast area.

Speaker 1:

So you add a natural layer right.

Speaker 2:

It provides better coverage, can help shape things nicely, improve the contour and just make everything feel more natural, especially when you combine it with the implant placement itself okay, what about um rippling or wrinkling?

Speaker 1:

Some people worry about seeing the edges of the implant.

Speaker 2:

That's definitely a consideration. Dr Kim says it's more likely to happen with above the muscle placement, also more common with larger implants and again in people with lower body fat.

Speaker 1:

So are there ways to minimize that?

Speaker 2:

Yes, he lists a few strategies. Choosing silicone implants instead of saline can help, sometimes slightly overfilling the implant. Opting for that subfacial placement can be better than above the muscle and, like we just discussed, using fat grafting adds that extra layer of camouflage.

Speaker 1:

Got it. And one more aesthetic point cleavage. Does placement affect how close the breasts appear?

Speaker 2:

It absolutely can. Dr Kim notes that getting that closer, look more prominent cleavage is often a bit easier with placements that aren't fully under the muscle, like subglandular or subfacial.

Speaker 1:

Easier, not under the muscle.

Speaker 2:

Generally yes. However, he's quick to add that surgeons can modify the dual plane technique using specific surgical maneuvers to achieve good cleavage too. It's definitely something specific to discuss, based on your goals.

Speaker 1:

Okay, so lots of factors playing into the decision. Finally, did Dr Kim give any sense of where things might be heading, like future trends and placement?

Speaker 2:

He did share his perspective. He actually thinks that subfascial placement under the fascia might become more and more common.

Speaker 1:

Really. Why is that?

Speaker 2:

He feels it gives surgeons great control during the procedure. He also mentioned the potential for achieving really good cleavage with it and, importantly, the better patient comfort during a recovery plus potentially better long-term results he's seeing Especially for active people. Especially for active individuals. Yeah, he seems quite positive about its potential.

Speaker 1:

Interesting. So, pulling this all together, it's clear that understanding where a breast implant goes is well a lot more complex than just above or below the muscle.

Speaker 2:

Definitely it's this whole balancing act. Isn't it Weighing the risks, the look and feel you want, how recovery might go your lifestyle?

Speaker 1:

Realizing that under the muscle usually means that dual plane approach with its own pros and cons.

Speaker 2:

Right, and then you have this sub facial option emerging as a really interesting alternative, particularly for certain people.

Speaker 1:

It really makes you think the placement choice impacts so much, which kind of leads to a good question for you listening at home.

Speaker 2:

Yeah, if you were exploring this further, thinking about these different placements and what they mean, what would be your number one concern? Would it be maybe the recovery time and comfort?

Speaker 1:

Or perhaps getting the most natural possible look and feel.

Speaker 2:

Or maybe how it fits with your activity level long term. It's different for everyone.

Speaker 1:

Definitely food for thought for everyone. Definitely food for thought. And hey, if this discussion sparked more questions for you, Dr Kim actually has other videos on his YouTube channel covering related stuff. Could be worth checking out if you want to dive even deeper into certain aspects.

Speaker 2:

Absolutely, and you could also peek at the comments section on Dr Kim's original video. Sometimes seeing the questions other people ask and the discussions there can be really helpful too.

Speaker 1:

Thank you for listening to the Beauty Standard with Dr Roy Kim. Make sure to follow for future topics and episodes.