Which Breast Implant Placement is Least Likely to Cause Sagging?

The truth is that the most common cause of sagging or "bottoming out" of breast implants is that the breast implant pocket has been placed too low. The inframammary crease is a natural landmark and should not be violated during breast implant surgery--if it is, the implant will migrate down.
This can happen with either a submuscular or subglandular breast implant placement.
So, most important for you is to find an experienced board certified plastic surgeon who does a lot of breast surgery-i recommend consulting two doctors.
Another important issue is the strength of your tissues and the amount of breast tissue that you have.
Patients with very little breast tissue and thin skin are more prone to stretchinmg of the skin with time, and in these patients I do recommend the submuscular placement.
Some doctors leave a wide opening at the bottom of the chest muscle through which the implant is placed beneath the muscle-in these cases the implant often sags or is displaced below the muscle-so the advantage of submuscular placement is lost.
Too large implants are more prone to sagging.
The key is finding the best plastic surgeon and specifically ask questions about the above.
A properly placed moderately sized subglandular or submuscular implant in a patient with normal amounts of breast tissue and thick healthy skin should not sag.

There is solely no consensus.  #Sagging can occur due to many reasons.  Some include the #size of the breast and implant,  #weight of the breast and implant,  #gravity , #age and/or aging, #weight loss and weight gain.  #Tissue integrity (ie. some women are more prone to experience sagging due to weakness of their skin and breast #tissue at the fold).

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. Bottoming out is a possibility with either position.  As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits. Hope that this helps! Best wishes for a wonderful result!