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 (23)

The natural looking breast implant

+4

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 41 reviews

Subglandular better to lift droopy breasts

+3

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 1 review

Submuscular vs Subglandular Breast Augmentation

+2

I almost always perform submuscular breast augmentation as the results are more natural. I also insert a pain pump top control post-operative pain. Discuss your specific concerns with your Board certified Plastic Surgeon. Please trust in your surgeon as He/She wants to achieve the best results possible. Best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

You might also like...

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

+2

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 10 reviews

Breast Enhancement Surgery

+1
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

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
5.0 out of 5 stars 35 reviews

Submusclular or subglandular.

+1

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.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 13 reviews

Position Of Breast Implants?

+1

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. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.


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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

Submuscular breast implants

+1
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 37 reviews

No approach is better

+1

There are essentially 3 approaches to breast augmentation, subglandular (subfascial), submuscular, and dual plane (partially submuscular). The approach chosen depends on many factors, including the appearance of your breasts, tissue thickness, breast position and of course the type of appearance of your breasts that you are looking for. All the approaches mentioned have advantages and disadvantages. The main disadvantages of subglandular are a higher capsular contracture rate and visibility of implants if your tissues are thin. This can also be affected depending on your choice of saline or gel implants. 

Ideally choose a surgeon that can offer you all approaches, under, over and dual plane, as well as saline, gel and even fat grafting for breast augmentation. You should also be able to discuss your choice of incision. The discussion should include your actual body and breast type, tissue thickness, how you expect to look, advantages and disadvantages of each approach.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 35 reviews

Breast Augmentation and placement

+1

I prefer the dual plane approach (partially submuscular) in most patient due to the decreased risks of a capsular contracture.  Subglandular is certainly an option if there is adequate tissue coverage.  I would not count on the subglandular placement to necessarily fix your drooping.  It may be that a lift is also required. You would need a complete evaluation to determine this.

David Nicholas Csikai, MD
Jacksonville Plastic Surgeon
5.0 out of 5 stars 31 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.