Submuscular vs. Subglandular - Which is Better?

I'm worried because my surgery is soon and some have mentioned a rt breast lift is not a good idea or thigh lipo. I heard the chest muscle dies with submuscular placement and that subglandular was better, created better cleavage and filled in the upper pole, so now I'm confused, my surgeon is planning sub muscular, but I called yesterday to see if he does subglandular, any help or suggestions? I'm scheduled to have a tt, rt lift, augment w/ saline 400+cc, lipo on flank, inner/outer thigh. Thanks

Doctor Answers 18

Implant Placement

Implant placement relative to the pectoralis major muscle continues to be a source of controversy. Although the majority of plastic surgeons prefer submuscular placement there is still a large group of plastic surgeons who feel strongly about subglandular placement. Each group can make convincing arguments regarding their position of choice. It’s safe to say both approaches have advantages and disadvantages.

In the context of these discussions we feel that every patient needs to be considered individually. Each patient has unique anatomic findings that effect the decision to place the implant under or over the muscle. The aesthetic goals of the patient are equally important and have a significant impact on the decision as well. The vast majority of patients are striving for larger breasts with a natural look. They want balance, harmony, and proportion with the surrounding structures.

The majority of breast implants are placed in a submuscular position. There are several advantages to this approach. These include more soft tissue coverage which results in fewer visible folds, creases, and ripples in the implant. This is especially important in women who have thin skin and minimal breast tissue who want saline implants. Another advantage of submuscular placement is a lower incidence of capsular contracture. This phenomena results in hardening and distortion of the breasts. Patients can also have significant pain with capsule formation. Capsular contracture can occur with the implant in either position but the incidence is higher when the implant is placed on top of the muscle. For these reasons, submusclar placement gives a more natural look in most cases.

Placement on top of the muscle should be considered in female body builders who have large muscles which can distort the implant during contraction. In women with breast sag, implants can be placed on top of the muscle to avoid a breast lift and scarring.

Every patient should be considered individually. It’s important that you meet with a board certified plastic surgeon who can help obtain your aesthetic goals. 

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Depends on your body and goals

SUB-MAMMARY POCKET (over the muscle)

The implant is placed over the chest muscle, under only the breast tissue.
- good for women with more of their own natural breast tissue so the implant can be hidden better. Also good for tuberous breasts.

SUB-PECTORAL POCKET - Dual Plane (under the muscle) - more common

The top part of the implant is placed under the chest muscle and the bottom third is covered by breast tissue.
-creates a natural teardrop shape. The implant is better covered so it's better for women with less of their own breast tissue. Makes mammograms easier to read.

You should trust your surgeon's suggestion.

Submuscular versus Subglandular ? Which is better

Most plastic surgeons seldom perform purely subglandular augmentation for several reasons. Firstly with the incorporation of dual plane techniques over the last 15 years , the advantage that subglandular placement had when there was a bit too much skin excess and the patient wished to avoid a lift has been replaced by this superior technique. In those cases when the implants were placed under the breast alone years later they tend to appear unnatural . With saline implants rippling would become more noticeable and the breast would develop a melon like appearance . When the implant is placed in a submuscular  position the superior pole transition is more natural and there is less chance of distortion over time.  The chance for capsular contracture is greatly reduced and mammograms are easier to perform. It is not uncommon for a plastic surgeon to switch implants from a subglandular to a submuscular  position because of complications, but seldom the other way around.

Implant placement

Your skin quality is the main determinant of location and so the best person to answer this question is your plastic surgeon. In my practice a majority of women get submuscular implants or dual plane and especially in those women who have lost weight or have a lot of extra skin. The skin has lost volume and elasticity and as such cannot bear the weight of the implant. BTW the chest muscle does not die. That is absolutely false.

Raj S. Ambay, MD
Brandon Plastic Surgeon
4.0 out of 5 stars 24 reviews

Breast implants submuscular vs. subglandular

Generally speaking submuscular implant placement is preferred for most patients.  Submuscular implants will not cause the muscle to die.  Advantages of submuscular placement include:

-lower risk of contracture

-lower risk of visible rippling 

Subglandular implant placement is possible in certain individuals, particularly in individuals with a fair amount of natural breast volume.

In your case, I would definitely recommend submuscular implant placement

Andrew P. Giacobbe, MD
Buffalo Plastic Surgeon
5.0 out of 5 stars 14 reviews

Implants below or above the muscle

I would agree with most of the previous posts that submuscular is better for most patients.

The major advantages of submuscular placement include 1) softer coverage, 2) less risk of rippling, 3) improved upper breast shape.

The major disadvantages of submuscular implants are 1) A little more painful recovery, 2) implant movement with activity (this can be minimized by appropriate muscle release).

York J. Yates - Utah

York Jay Yates, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 68 reviews

Sub Muscular versus Sub Glandular Breast Augment

Whenever possible, I prefer Sub Muscular Breast Augmentation. The more of you there is over the implant, the more it will look and feel like you, and the less it will look and feel like an implant. This is especially important in patients who are thin or have very little native breast tissue.

Based on your photos I believe you will do better with a Sub Muscular Augment. Good luck!

Mark Preston, MD
Columbus Plastic Surgeon
4.5 out of 5 stars 12 reviews

Subglandular or submuscular for Breast Augmentation?

I feel that both positions have a role in Breast Augmentation.  There is no question from the medical literature that the submuscular or dual-plane approach has a lower rate of certain complications such as capsular contracture.  However, there are some disadvantages to this approach as well, including the possibility of breast drooping beyond the position of the implant.

Jeff Scott, MD
Everett Plastic Surgeon
5.0 out of 5 stars 9 reviews

Under or over the muscle with implants - which is better?

There is not really one best answer to this question. The positioning of implants is really left to the patient to select with her surgeon's guidance. My general recommendation is to place the implants under the muscle. The gives a more natural look after surgery, provides a healthy blood supply to surround the implant, and leaves more tissue to cover the implant. In my practice I only recommend that patients who rely on their pectoralis (chest) muscles for a living have their implants over the muscle. I have operated upon body builders, gymnasts, and one trapeze artist who all preferred to leave the muscle untouched. Generally I recommend under the muscle. And in your case I would still recommend going under the muscle.

I hope this info helps!

Adam Rubinstein, MD
Miami Plastic Surgeon
5.0 out of 5 stars 11 reviews

Submuscular versus Saline Breast Augmentation

In your case, you have very little native breast tissue and I would recommend submuscular implant placement.   This will still give you upper pole fullness and cleavage with your breast shape, but decrease your chance of scar tissue formation and rippling in the upper half of your breast.   I find it hard to tell whether you would benefit from a right breast lift based on your photos.   I wish you a safe and healthy recovery.

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 50 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.