Why does subglandular get such a bad rap in the U.S?

When silicone gel implants are used in most circumstances sub glandular placement is aesthetically better. There is the misconception that sub muscular implants decrease the risk of bottoming out. In truth it's the other way around. I agree with you that sub muscular placement of implants is held in unnecessarily high esteem in the United States.

Subglandular implants are a minority in the US, but are increasing in popularity.  I often place silicone gel implants in sub glandular pockets for selected patients.  Excellent, very natural results can be achieved, in many cases, better than sub muscular.  The newer gel implants are well suited to sub glandular placement with less rippling. Capsular contracture rates may be somewhat higher, but I believe the overall reoperation rate is similar when all problems requiring revision (muscular distortion, asymmetry, implant malposition, capsular contracture,  and other reasons) are taken into account.

Great question. I have been a fan of subglandular breast augmentation for
the past eight years. This is after at least that long placing implants
strictly under the muscle. I do not understand why we are slow in America
picking up on this trend. The new technology implants make the choice a
no-brainer in my practice.

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  

Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

Director-Beverly Hills Breast and Body Institute

#RealSelf100Surgeon

#RealSelfCORESurgeon

Thank you for sharing your excellent question.  In general implants are placed more frequently under the chest muscle as it affords a more natural shape and appearance, increases soft tissue coverage of the implant, and trends towards fewer complications like capsular contracture.  Ultimately once you have met with your plastic surgeon and discussed the pros and cons of each placement location the decision is yours as to which position you would like the implant placed.  Hope this helps.