I have thick skin, can pinch about an inch, my nipple measures 24" from the shoulder on one side and 23" on the other. and I have quite a bit of space between my breasts. I am a low to middle B cup size My PS is suggesting high profile sub-glandular which worried me at first but then I have read my characteristics call for this placement. Do you agree?
I Will Be Having my Implants Sub-glandular and It Seems I Fit the Qualifications? (photo)
Doctor Answers (18)
Subglandular vs submuscular breast augmentation for slightly droopy breasts
Based on both my own experience performing breast augmentation for over 26 years and much of the published literature on the subject, there are no indications for doing a straight subglandular augmentation.
In fact, over the last 15 years, I have not performed a single, purely subglandular augmentation. What's more, the vast majority of revision cases I've performed have been on women wanted/needing to go from a subglandular to a submuscular positioning.
In the past, subglandular augmentations were performed to avoid the possibility of a mastopexy, but in most of these cases, the breasts developed a drooping, melon like appearance, particularly with saline implants (often described as the "rock in a sock" look).
In cases where mild glandular ptosis exists, the best approach is a dual plane augmentation because it elevates the nipple-areola-complex (NAC) and slightly lifts the breast. When mild glandular ptosis is not present, a standard submuscular placement will provide the most natural looking result.
Please see the before & after photo gallery linked to below for an example of a young lady who had breasts very similar to your own (re: slightly ptotic) before undergoing a submuscular augmentation.
Breast augmentation above or below the muscle
Under the muscle or Above the Muscle?
I also almost always place implants utilizing a dual plane technique under the muscle, above the muscle is certainly a quicker recovery with quicker results but there are lots of long term negatives associated with this type of placement. I would consult with a few BC PS before you make any mistakes. You obviously do not feel confident in your surgical plan so I would continue until you are confident in your surgeon and his plan.
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Subglandular versus submuscular breast implants
When I started out in practice 22 years ago, I put all of my implants in the subglandular position because that is where my dad put them for 40 years. He felt that that was where your breast tissue was and therefore that was where the implants would look and behave more like your breast tissue. Although I believe he was right in theory, I have changed my philosophy over the years. Now I put almost all of my implants under the muscle. I think most plastic surgeons do. It takes longer for the muscle to loosen up and for you to get to your end point, but I think it is worth the extra time. I do this for three reasons: 1. with saline implants, the extra muscle coverage minimizes the chance of seeing/feeling ripples or wrinkles. 2. the massaging action of the muscle over the implant minimizes the risk of capsular contractures, thick scar tissue that can develop around an implant causing the breast to become firm or distorted in appearance. 3. There is some suggestion in the literature that it is easier to perform and to interpret mammograms when implants are placed under rather than over the chest muscle. If you came into my office, I would probably recommend putting your implants under your chest muscle, based on your photo.
Sub glandular implants
I also do not place implants in the subglandular position except on very rare occasions. I am sure that you can find a good surgeon that can do so for you and you might have very nice results. I certainly have seen other surgeons' patient' in follow up with subglandular implants that look quite good even many years after their procedure. But I have also seen other surgeons' patients in follow up with subglandular implants in which the skin has become extremely thin and the implants have bottomed out. These are often very difficult to fix. Most of the capsular contractures that I see in my practice are subglandular implants. I think that the subglandular breast augmentation should be reserved for a very small subset of patients and I don't think that you would meet my criteria for considering it. It isn't that you are a bad candidate for subglandular implants, it is just my opinion that there is no reason for you not to place them in the dual plane or subpectoral space.
High profile implants placed in the subglandular position may look good at first but will likely wear on your tissue over time
A word of caution. High profile implants placed in the subglandular position may look good at first but will likely wear on your tissue over time causing tissue stretching, thinning and lead to implant rippling and being able to feel the implant.
To see what the best options are for you, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery. I hope this helps.
Sub-Glandular (above the muscle) placement of Breast Implants
There is really no advantage to placing breast implants above the muscle, in comparison to a lot of advantages to placing them under the muscle. In addition, remember that you have breast that sit far apart on your chest wall. Using High Profile implants will not help to achieve a better cleavage, as the base or diameter of the implants are smaller than a Moderate Profile breast implant.
Above or Below Muscle?
It is difficult to give you the absolute answer without a physical exam. Based on your picture I would recommend the implant be placed below the muscle. You do not appear to have adequate thickness of tissue of the upper breast to cover the implant if it is placed subglandular.
Sub-glandular vs. Sub-muscular
The principal advantage of placing implants above the pectoral muscle is the absence of "animation," or motion of the implant when the pectoral muscle is flexed. While that is important to a few patients, that advantage is usually trumped by the advantages of sub-muscular placement:
- less risk of capsular contracture
- less chance of feeling or seeing ripples
- more natural appearance at the upper pole of the implant.
I don't see anything in the photo or measurements that "calls for" sub-glandular placement. Although that may be acceptable, my preference would be for sub-pectoral placement.
Thanks for the question, the photo. Best wishes.
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.