Subglandular vs. Submuscular with Lift Breast Augmentation?

I have seen my PS and I have a date scheduled 5 months from now for subglandular breast implants because I have a droop. But he gave me two options, this option or getting a Breast lift and submuscular Breast augmentation. I am rethinking and may choose the lift with submuscular. I just want something that will be better for me in the long run with less complications than the other and not necessarily faster healing but better healing. It is my first augmentation and I am 33 year old with one baby possibly 1 more. What are your opinions?

Doctor Answers (13)

Implants without lift

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95% of my patients who have been properly selected for breast augmentation without a lift to address sagging are satisfied with the amount of lift they achieve with implants. The right implants and technique can help you address mild to moderate sagging with breast augmentation alone, by taking into account the size you'd like to be and the amount of lift you require during the pre-surgery planning process.

These three things are considered to help give you the extra lift you require to make your breasts “perkier” without mastopexy:

1) During your breast augmentation, the breast implants will be placed directly under the breast tissue and above the chest wall muscle (in the sub-mammary position).

2) The best breast implants to use for a perkier result contain silicone gel that is more cohesive, such as the Allergan Inspira Truform 2 (formerly known as Soft-Touch gel). These implants are slightly firmer to maintain their shape better, but still retain their natural feel.

3) The shape of your breast implants should have more, rather than less, projection. Breast implants with a smaller base width will make your breasts project more forward from your chest wall and body, creating a more prominent contour. “Profile” is a synonym for projection, therefore look for high profile implants.

Generally speaking, larger breast implants can also help give a better lift, sometimes raising the position of the nipple by one or two centimetres.

Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate. Best of luck.


Toronto Plastic Surgeon
5.0 out of 5 stars 69 reviews

Lift vs subglandular implant

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Subglandular placement always look good right away, but the weight of the implant will further stress your tissue over time, and result in breasts that hang even lower.  Submuscular breast implants with a lift, will likely result in a more favorable long-term result. 

Dennis Dass, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 56 reviews

Breast Augmentation/Breast Lift Implant Positioning?

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Thank you for the question.

In general, I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 781 reviews

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Subglandular breast augmentation or submuscular augmentation and lift

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If you have minimal ptosis (or sagging) of your breast, a subglandular placement might give a nice result with fewer scar lines or incision lines. However, your mammogram may be adversely affected by going with a subglandular implant--although in my experience your physical examination would not be adversely affected.

If you have significant sag then I would typically recommend a submuscular implant with a complete breast lift, though you will have more scars. It's difficult for me to say for certain without having seen you myself, as everyone's body is different.

Deason Dunagan, MD
Huntsville Plastic Surgeon
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Submuscular Augmentation with or without a lift

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The submuscular placement of the implant offers clear advantages whether an augmentation alone or a mastopexy-augmentation is performed. The key to the success of an aesthetic appearing breast is having the implant covered by as much tissue as possible. When an augmentation is performed in a patient with ptosis (sagging), the upper pole of the breast usually has very little tissue to cover the implant (this part of the chest is usually flat and usually one of the reasons the patient seeks augmentation in the first place). If an augmentation is performed on top of the muscle, a long term unnatural appearance in the upper pole can occur. If the implant is placed under the muscle, the upper pole of the implant is now covered by the muscle resulting in a more natural appearance.

Placing the implant under the muscle in a breast with sagging is performed by creating a bi-planar or dual-planar dissection. I prefer to do this through a hidden armpit incision.

I usually recommend to my patients choosing an augmentation or a mastopexy-augmentation based on the look they choose to have following the procedure: not based on implant location. Several factors must be evaluated: scars, shape to the breast, size, etc. But in my opinion, the patients desire for the shape of the breast is the key component to the choice of the procedure.

Marc Schneider, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 10 reviews

Breast lift with submuscular implants is a better choice

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The choice of submuscular implants with a lift is a better choice that subglandular implants without a lift. There is no comparison long term between these two. The subglandular option will eventually look like a ball in sock possibly and won't give you much of a lift at all. The submuscular implant doesn't have to be bigger than you want and the lift will reshape the breast, tighten the skin and elevate the nipple areola to a youthful posiiton.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 51 reviews

Breast lift and Augmentation

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Your question is very hard to answer. Usually, if one needs a lift, one needs a lift. There are, however, several methods of doing lifts. In addition, the implant itself, if large enough, can correct some droop. The question of position is a wholly different matter. If I am trying to get any lift with the implant or am doing a lift at the time of augmentation, I never place the implant below the muscle. The reason is simple; by dissection on top of the muscle I free the breast to move up. This does not happen with a sub muscular implant.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Breast lift vs implant position

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Your situation is not uncommon and there is no right answer. None of the options is ideal. If you just put in implants you will still have some drooping but less scarring. If you do a lift and implants you have much more scarring but markedly improve the drooping f the breast.

I suggest you look at photos of each adn se what you might prefer.

Either way there is a high chance of additional surgery in your future to revise what has beed done.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 17 reviews

When in doubt, do a breast lift with breast implants.

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Hi.

Cannot give you specific advice because everything depends on the details of your anatomy, but the mere fact that the topic came up usually means that you will do better with a breast lift with breast implants.

Women accept the scars very well if they love their new breasts. Some surgeons are afraid to recommend breast lift because they are afraid of scaring the patient.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Implants under the muscle with breast lift

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Although I can't say without seeing you, in cases where there is some drooping many plastic surgeons recommend putting the implants above the muscle so they can sort of drop into the skin envelope and avoid doing a lift. The downside of this approach is that it doesn't really lift very muh and can progess to what is decsribed as a "rock in a sock" look which you do not want. When a lift is done at the same time, the implants need to be under the muscle, and that with a lift is a more stable long-term situation in most cases.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 28 reviews

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.