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

I know 70% US breast augs are submusc but in Europe more are subgland. I know about mammograms and capsular contracture. Purely cosmetically speaking why isn't subgland more popular here as it is there? Esp. since we use silicone mostly now. What are the cons cosmetically, esp. long term? What is breast feeding risk since you're close to the glands? What placement do you think she has? I was a small D, now small B want C no lift needed. What size is she? How would you get this round look?

Doctor Answers 11

Why does subglandular get such a bad rap in the US?

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.

Sub glandular breast implants are unfairly criticized in the United States.

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

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

The preference for submuscular placement of breast implants is better coverage long-term and the risk of capsular contracture.  With time subglandular implants become more visible as the overlying breast tissue thinness.   I do not think there is a difference in the right of breast feeding difficulties between submuscular and subglandular.  I cannot tell what size implants the patient has in the photo you provided.  Sizing should be based on the base width of your breast.  To learn more about sizing you may do the Rice test at home which is described in the link below:

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

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.


Adolfo Sesto, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 41 reviews

Dr Kayser

Thank you for your question. Implants are typically placed under the muscle to allow better coverage in the cleavage areas and upper portion of the breasts. It is also thought to help decrease capsular contracture. Finally there is the potential advantage to having less interference than an implant placed above the muscle when it comes to mammograms. The disadvantage would be an increase the gap between the breasts and also the potential for distortion of the implant when the muscle contracts which is referred to animation deformity. This can be particularly disturbing in patients who are lean and athletic.

Implants placed above the muscle are generally reserved for patients who might have adequate coverage in order to decrease the risk of both visible and palpable rippling or in women who may have breast ptosis which would place the implant significantly lower than Where adequate muscle coveragevwould exist. However, this would completely eliminate a problem with the animation deformity and also improve the gap between the breasts. There is some data to suggest that if an implant is placed above the muscle, the use of a textured device can help decrease the capsular contracture risk. Both approaches place the implant beneath the breast gland itself so breast feeding is no affected with either method.

The most current approach is to have implants placed above the muscle in combination with fat transfer. This would allow the placement of fat from one part of the body to the areas of the breast that may not have as much coverage. Fat is natural and once integrated into the tissue, has the potential to last a lifetime. Finally it is also an approach which allows filling up the contours of the breast that an implant simply cannot reach.

In any case I would certainly recommend a consultation with a board certified plastic surgeon who is experienced in all types of breast surgery and fat transfer as this can be very technique dependent. Please view the attached video which describes a patient who has had this exact situation where implants were actually transferred from behind the muscle to above the muscle with the addition of fat. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Great questions

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.  

Saira Saini, MD
Fayetteville Plastic Surgeon
5.0 out of 5 stars 3 reviews

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

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

Why does subglandular get such a bad rap.

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.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 40 reviews

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

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.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Implant Placement

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. 

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.