What is the Difference Between Submuscular and Partial Submuscular Implants?

There are some important aspects to how breast implants are placed when under the muscle. Most implants are placed under for better coverage, primarily in the upper part of the breast. The pectoralis muscle is shaped like a Japanese fan, with the "handle" attaching to the upper arm and the edges attaching to the breast bone and the rib cage. The part that attaches to the ribs is higher than where the bottom of the breast is, so it is usually detached in order to let the implant sit lower where it is centered under the breast. The problem with this technique, often called "dual-plane" because part of the implant is under and part covered only by the breast, is that the part of the muscle that used to attach to the rib cage now attaches to the implant capsule where it can pull and cause what are called "animation deformities." The split muscle technique avoids this by covering the upper part of the implant but leaving the lower half behind it. That way you get coverage where it is needed but avoid animation problems. (Total under muscle coverage isn't practical for augmentation for a number of reasons.)

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and hide rippling of the implant. Implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture).  Also, breast cancer screening with mammography gives better images of breast tissue when implants are placed under the muscle. Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. Although a small animation deformity will develop with submuscular implant placement, in my patients this is typically minimal and most women don't notice it at all. I believe that the pros of placing implants under the muscle outweigh a minor animation deformity that typically develops. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Each are beneficial according to implant type and placement. The possible benefits of #submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.This #sub-glandular #placement may allow for a shorter surgery and recovery with less discomfort. This placement can provide a slight “lift.” #Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.The #Dual-Plane placement method is a more current technique most often used when there is mild breast sag and the patient does not want a breast lift. The breast tissue and muscle are partially separated to allow the breast tissue to sit in a better position. Dual-plane can be discussed further during the consultation should breast sag be of concern.

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

If you want to prevent an animation deformity (which is when the breast implant moves when the pectoral muscle contracts) you would want the implant located in a subglandular position (in front of the muscle). This location can make mammograms more difficult to interpret and have a slightly higher incidence of rippling, but if you're very athletic it is an option.

I recommend consulting with a board certified plastic surgeon to discuss this in further detail and have a complete examination.

Best wishes,

Dr.Bruno

Most prospective breast augmentation patients are familiar with the concepts of placing implants under or over the muscle. Each of these general approaches have a large number of variations that Plastic Surgeons consider and tailor to each patients unique needs. By far the most common approach is a "partially sub-muscular" or sub-pectoral positioning of the breast implants. Depending on the muscular anatomy, the pectoral muscle covers the upper 1/3 - 1/2 of the implant with the lowermost part of the implant covered by the breast tissue only. Another variation of this position is referred to a dual-plane technique. Totally sub-muscular implant locations are used much less commonly in elective breast augmentation surgery. This technique requires the adjacent muscles on the chest to be elevated along with pectoral muscle.

In order to decrease the dynamic shape changes to the breast that occurs with muscular contraction, slight variations in technique can be considered. Dual-plane, split muscle and sub-fascial techniques each have benefits and trade-offs.  The split muscle pocket is not popular with most Plastic Surgeons because of the added surgical trauma required and the more limited coverage provided by using only the upper portion of the pectoralis major muscle.

There is no one particular technique that is far superior to others or that is the best choice for all patients. Some shape and position change occurs during muscular contraction in all techniques where some or all of the muscle is used to camouflage and cover the implant.

Dr. Mosher