Are Bicep Implants Better To Be Placed Above Or Under The Muscle?

Q: Dr. Eppley,   I was wondering because I have heard and noticed all surgeons do the bicep/tricep implant insertion differently. Some state that under the muscle can look better and hold better in place but there is the risk of nerve damage going underneath the muscle. I have heard that placing it on top of the muscle/underneath the fascia is much more safe but the implant is more noticeable and can even be felt and one could tell it is an implant?

Is that true? What are your thoughts on that? My goal is to have implants stay tight and not be noticeable or felt. If someone could feel my arm and tell an implant was there, then I think it would make more sense to place it under the muscle as it would hide better.

A: I think everything that you are stating about the two different pocket locations for upper arm is largely accurate with these 3 caveats. 

1) Under the muscle (on the bone) implants will not be as big or noticeable due to the need to use smaller implants.

2) There will be a more visible scar with under the muscle arm implants due to the need for a medial arm incision location.

3) Most of the subfascial implant visibility issues are circumvented with a custom implant design approach where the edges are feathered and not round like in standard implants.

4) Potential injury to the musculocutaneous nerve does exist with under the muscle implants. This is a motor nerve to the forearm and hand. While rare it is an issue to consider.  

Dr. Barry Eppley

Indianapolis, Indiana