What's Better - Submuscular or Subglandular?

Im 20yrs weight 145 ht 5'0 36b .. and I have a lot of breast tissue mild droop. i had 1 baby and breastfed. what would look better and natural submuscular, partial, duel or subglandular? thks for ur help

Doctor Answers 26

The natural looking breast implant

I offer patient's a simple analogy to illustrate what we mean:

Q: If you take a baseball and you cover it with a silksheet, what will it look like?

A: Like a baseball, you will even see the stitching.

Q: Now if you take that same baseball and cover it with a comforter what will you see?

A: It depends on how thick the comforter is but generally you will see a softly shaped lump.

So now the question is what do you have on your chest, silk sheets or comforters?

The way we determine this is by looking at your chest, if I can see your ribs (under the muscle) then you anatomy will have a hard time disguising the implant whether it is placed under or over the muscle and you are more likely better off with a silicone implant. Another way of measuring this is to pinch your upper chest skin (similar to pinch and inch of your waist on the Special K commercial). If you have less than an 2 cm (under 4/5 of an inch) than you have "silk sheets"

If you have a thicker skin/fat/breast layer that pinches over an inch than you have the option of going under or over.

Now the exception to the rule:

Q: What happens if you change the baseball to a volleyball?

A: All bets are off, whether you put it under or over the muscle it will not look natural.

The last issue is the implant shape. There are some anatomic shaped implants but I have generally found them to produce no significant difference in outcome with the exception of breast cancer reconstruction. However, this is my personal opinion.


Chicago Plastic Surgeon
5.0 out of 5 stars 56 reviews

Subglandular better to lift droopy breasts

If you have some drooping of the breast tissue, such that the nipple is lower than the level of the crease under the breast (where an underwire would go), subglandular implant placement is probably a better choice.  It sounds like you have enough breast tissue to cover the implant well, such that visible implant edges and ripples shouldn't be a problem. 

Amy M. Sprole, MD
Wichita Plastic Surgeon
5.0 out of 5 stars 2 reviews

With early ptosis and enough breast tissue, I feel that sub glandular gel implants give far better results with a breast augment

I feel that when ever the woman has adequate breast tissue to cover the gel implants, sub mammary or sub glandular placement of the breast implants gives  much more natural looking and feeling breasts with breast augmentation. This is especially true if there is some early ptosis, drooping of the breast. 


When the woman has very little breast tissue, putting it under the breast often will lead to ripples and folds that can be felt or seen. In these cases it is necessary to put the implants under the muscle but I would definitely prefer gel implants over the saline again for a more natural look and feel. 

If  you do develop ripples or folds they can often be covered by fat grafting to the breast. 

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 13 reviews

Each patient is different, most surgeons prefer submuscular.

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 a convincing argument 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 affect 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 implants in either position but the incidence is higher when the implant is placed on top of the muscle.For these reasons, submuscular placement gives a more natural look, in most cases.
Placement of the implant on top of the muscle should be considered in female body builders who have large muscles which can distort the implants during contraction.In women with severe breast sag, implants can be placed on top of the muscle to avoid a breast lift and scarring.
When patients have mild breast sag, a duel plane breast augmentation offers the advantages of submuscular placement while also addressing breast sag.In your case, this may represent your best option.It’s important that every patient be considered individually.It’s therefore, important to consult a board certified plastic surgeon who has experience in this area.

What is best submuscular or subglandular breast augmentation?

The advantages of a submuscular placement are significant. Implants placed underneath the muscle have more soft tissue coverage and therefore have a more natural appearance and less likelihood of the borders of the implant being obvious. Submuscular placement also has less chance of capsular contracture and mammography is more accurate. One of the disadvantages is temporary "flattening" of the breast when the muscle is flexed. I routinely place implants in the subpectoral position in patients who engage in bodybuilding and fitness competitions. When discussed preoperatively patients except this flattening as a trade off for a more predictable and trouble-free long-term outcome. If consideration is given to placement of the implant above the muscle it is important that the patient have sufficient soft tissue coverage between the skin and the implant. Its important to have at least a 2 cm pinch test in the upper portion of the breast. This is determined by the surgeon pinching the tissue in the upper portion of the breast to make sure there is at least 2 cm between the thumb and index finger.

John J. Edney, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 81 reviews

Depends on your body

Your surgeon will help you decide which implant pocket placement is best for you prior to surgery, taking special care to select one that will achieve your personal goals and expectations. You may benefit from a silicone implant with a firmer texture and narrow base width to address mild sagging.

Breast Enhancement Surgery

Way too much to talk about it hear, if you have good soft tissue or upper breast skin thickness and you use your muscles a lot or work out than I think subglandular is a good alternative for smaller implants

Submusclular or subglandular.

The sizes are done with the width of the chest wall. 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.

Position Of Breast Implants?

Thank you for the question.
Generally implants should be placed in the partially submuscular position (dual plane) for the best results and avoidance of complications. 
Some general advice regarding breast implant sizing  may be helpful.
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.


2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. 



4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.


I hope this helps.

Submuscular breast implants

This may be a somewhat controversial statement, but in my opinion there currently is really only one acceptable position for breast implants in an elective cosmetic surgery patient: behind the pectoralis major muscle (sub-pectoral augmentation). There are a number of very compelling reasons to place implants behind the pec major, and the most compelling one of all is the fact that radiologists report that the mammographic imaging of breasts for the purpose of breast cancer screening tends to be more easily accomplished when breast implants are sub-pectoral (compared to pre-pectoral, also referred to as the 'sub-mammary' position). An American woman's current lifetime risk of breast cancer is approximately 1 in 8 to 1 in 9, so the issue of breast cancer screening must be taken very seriously. Mammography is by no means a perfect screening study, but it is the standard of care at this point in time. The most sensitive and specific test for breast cancer is a contrast-enhanced MRI scan, and breast implants do not impair breast tissue visualization by MRI.
The next very compelling reason to select sub-pectoral placement is a cosmetic one. Implants placed on top of the pec major tend to stand out in the upper pole of the breast, creating a rounded, convex and distinctly unnatural-appearing breast profile. With implants in a sub-pectoral position, the upper pole of the implant is flattened somewhat by the muscle, helping to create a smooth transition from the area in the upper chest where the breast begins, and a gradual slope towards the nipple that is not excessively rounded or convex. In some patients with a fuller breast volume preoperatively one may get an acceptable appearance with pre-pectoral placement - initially. The problem is that as breasts age, the fatty tissue atrophies and breast tissue thins out, and the area where this is most obvious is in the upper pole and cleavage area. So a pre-pectoral implant that was initially well-concealed may, after a few years, become painfully obvious (including visible implant folds and ripples) in the upper pole.
'Under the muscle' and 'sub-pectoral' are actually somewhat misleading terms, as in most cases the implant is only partially subpectoral. The anatomy of the pectoralis major muscle is such that it is actually just the upper/medial half of the implant that is covered by the muscle, while the lower/lateral half of the implant is submammary. The pectoralis major thus provides an additional layer of tissue to conceal the implant in the most cosmetically significant area of the breast: the cleavage area. This is why saline implants are often easy to feel laterally, as they are covered by breast tissue only in lateral aspect of the breast, and in slender patients who have small breasts preoperatively the implant is often immediately under the skin in this area.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 66 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.