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.  

To my knowledge your information is not accurate. Remember that the FDS prohibited the use of Breast Implants for about 10 years in the US, while in all the other countries we continue using and developing and perfecting techniques for their placement. Including Europe.Rippling is more common in the subglandular placement. Breast feeding risk is the same for both submuscular or subglandular placement.  For is not the location that may influence the capacity for breast feeding, but the technique use to introduce the implant to its location. So the Periareolar Technique Incision may adversely influence the breast feeding capacity rather than the Sulcus or Crease and the Axillary Techniques.

The big difference is the size of the implants.  I have reviewed several articles with breast augmentation procedures in the US and Europe.  The size of the implants is a major factor.  The second factor is the textured implant use is much higher in Europe.  Good luck with your decisions.  I think you should speak to a Board Certified Plastic Surgeon and let them examine you then the remainder of the questions can be answered more appropriately based on your circumstances.  

For surgeons with experience we have seen firsthand that subglandular implants are prone to capsular contracture and  over time will show through as the breast tissue thins. The result is a very round and stiff breast, or a breast that appears to fall off the front of the implant. We do not place the implant in a submuscular pocket because it is easy, but because we know that over long periods of time the implants will look better. This is true for most though not all, so ask questions carefully from your surgeon.

Subglandular placement can be a great option for some woman. It is just very important to understand the pros and cons so you can make an educated decision. 

Pros - easier recovery, more natural appearance 

Cons - higher rate of capsular contracture, can cause breast sag, implants fall into the armpit, if there is little breast tissue then rippling, folds, and other implant imperfections can show through, implants pushing onto the areolas can cause them to enlarge. 

Thank you for the question. Sorry, but online consultants will not be able to help you with accurate information in response to your question. Even if the exact breast implant size/profile was known, it may not be helpful information to you, since the same breast implants/profile may achieve a different outcome for you. "Purely cosmetically speaking", I think that breast implant placement in the sub glandular position (over the shorter or longer term) tend to be associated with more problems with visibility (rippling) or palpability.  Basically, the more coverage we have overlying breast implants, the better the long-term look/feel seems to be. You have mentioned some of the other problems associated with sub glandular breast augmentation surgery in your post. You will find a lot of information on this website regarding the pros/cons associated  with breast implant positioning options.  I think that the con of possible  "animation deformity" is known to you.





Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:







1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.



2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 



In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.



Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.



3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.







I hope this (and the attached link/video, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.