I am considering having breast augmentation. Should I go for sub glans or sub muscular? (Photo)

I am considering breast augmentation. The PS I will be using has suggested silicone sub glans instead of sub muscular for a more natural look. Which placement is better? Can sub glans implants end up sagging?

Doctor Answers 27


Couple of issues.  First I suspect that your plastic surgeon is very likely referring to the dual plane pocket when she/he refers to the submuscular pocket.  Very few surgeons employ a completely submuscular pocket for breast augmentation and therefore we tend to get a bit "loose" with the terminology.  

Second - there are situations when the subglandular pocket is actually beneficial to the outcome and there are situations when the dual plane pocket offers little or on balance no benefit to the subglandular or subfascial pocket.  When used correctly the subglandular or subfascial implant pocket can help optimize the result for the patient.  Certainly when done incorrectly the subglandular pocket can increase complications.  

I would suggest that you have a follow up conversation with your surgeon.  If your surgeon is well qualified (a board certified plastic surgeon, member of the ASPS and ASAPS) and very experienced in breast augmentation, then you are likely getting good advice.  In general these on line straw polls can be more confusing than helpful.

Boston Plastic Surgeon
4.5 out of 5 stars 23 reviews

235 Cypress St.
Brookline, MA 02445

Submuscular implant placement is preferred

There will be many different opinions about the best placement of an implant.  I fee that the submuscular position has several advantages including better coverage over the implant, a more natural slope to the upper pole of the breast, statistically decreased incidence of capsular contracture, and  better visualization of the implant on a mammogram.  Others will argue that these advantages do not exist but I believe that the medical literature and my personal experience argue for submuscular placement.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 13 reviews

3096 Peachtree Industrial Blvd
Duluth, GA 30097

I am considering having breast augmentation. Should I go for sub glans or sub muscular?

I recommend submuscular placement of implants for three reasons.

1. They look more natural as the pectoralis muscle gives a more natural slope in the upper part of the breast and not the bulging softball on the chest look of subglandular placement.
2. The muscle will separate the breast tissue from the implant for the majority of the implant so less tissue is hidden during mammograms (7-8% vs 23-25%).
3. There is less chance of capsular contracture or hardening of the implants when they are placed under the muscle.

The biggest drawback is the extra 2-3 weeks of healing as it feels like a pulled muscle on the chest. I believe this extra 2-3 weeks is worth the lifelong benefits from having them placed submuscularly. 

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 11 reviews

7735 W. Jefferson Blvd.
Fort Wayne, IN 46804

Nothing natural about implants

and if you're having smooth round implants on top of the muscle, they often turn to 'rocks in socks' years down the road.  A shaped implant on top of the muscle?  That should be better BUT they don't move around like normal breasts.  If you can handle the muscle distortion that comes from under the muscle, there are many advantages to going under the muscle if using smooth round implants.  Ask your doctor for rationale behind recommendations and you may better understand the reasoning.  But in my experience, I get a lot more 'natural' look when using a 'dual plane' submuscular placement.  And my competition, who exclusively uses subglandular placements, has more less than desirable results beyond the initial recovery period because I do their second opinions.

Curtis Wong, MD
Redding Plastic Surgeon
5.0 out of 5 stars 22 reviews

1950 Rosaline Avenue
Redding, CA 96001

Above or below the muscle

Thanks for your inquiry.  I see no good reason to place the implant above the muscle. Implants placed under the muscle have been shown to harden less and be less palpable and visible.  Good Luck. 

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 129 reviews

1870 Keller Parkway
Keller, TX 76248

Implant pocket position

I prefer to place most implants under the muscle because it adds more soft tissue coverage especially in the upper pole. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 20 reviews

1049 Fifth Ave
New York, NY 10028

Sub-pectoral vs. sub-glandular positioning of breast implants

I think the benefit of several decades of experience "proves" that positioning breast implants below the pectoralis muscle is the best way to go both short term and long term. I see no real advantages to positioning implants in the sub-glandular position and disagree with Dr. Setty about less painful (a very short term issue anyway) and a lift effect. Breast implants do not lift the breast up. They only "lift" them out. 
The key is to make sure the pectoralis muscle or its fascia does not cause problems in the lower pole of the breast. An adequate dual plane or split muscle technique must be done to avoid problems in the contour of the lower pole of the breast where the muscle or its fascia offers no advantages. In other words, if done properly, sub-pectoral positioning of the implant is clearly superior over sub-glandular positioning although I'm not convinced there is less capsule contracture with sub-pectoral positioning. I think (but can't prove) that this difference is because of using inframammary crease incisions rather than periareolar incisions. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

400 S McCaslin Blvd
Boulder, CO 80303

I am considering having breast augmentation. Should I go for sub glans or sub muscular?

The procedure that will give you an excellent and natural result is the dual plane subpectoral technique. You get the best of both the submuscular and the subglandular approaches. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 17 reviews

10201 SE Main
Portland, OR 97216

Sub muscular v. Sub mammary - why not both? #breastimplants

A nice approach is biplanar.  In this setting, the implant is sub muscular for approximately the top half and sub mammary for the bottom half.  The technique requires are more careful dissection, but you get the best of both worlds.

Mark D. Wigod, MD
Boise Plastic Surgeon
5.0 out of 5 stars 2 reviews

3630 E. Louise Drive
Meridian, ID 83642

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.