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

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.

Submuscular vs. Subglandular - Which is Better

Thank you for posting photos.  I prefer sub-muscular placement with saline implants when there is little breast tissue to start with, like yours.  The muscle will not die.  It will give better coverage of the implant with less liklihood that you will see rippling.  I personally would not lift your right breast with that size implant, but some surgeons would.

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 97 reviews

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.

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 17 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 89 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 16 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 10 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 12 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 60 reviews

Submuscular versus subglandular.

The choice between placing breast implants under the muscle versus over is dependent upon the amount of breast tissue and fat that you have. The goal is to conceal the implant so that the edges are not visible and to prevent the occurrence of rippling. The muscle does not "die" when you place an implant underneath it. Another advantage (which may be more theoretical) includes a lower rate of capsular contracture when the implant is underneath the muscle. With submuscular implant placement, the implant can definitely fill the upper pole and there is usually less of an issue with an implant "shelf" due to the smoother transition of the muscle. It is true that cleavage is lessened, however this can be compensated by using a slightly larger or more projecting implant. I recommend trusting the opinion of your plastic surgeon.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 13 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.