Submuscular vs subglandular breast animation and cosmetic concerns? (Photos)

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

You need to have a full discussion with a board-certified plastic surgeon. I
perform almost all my augmentations over the muscle to avoid breast animation. With the new highly
cross-linked silicone gel implants rippling is minimized. I prefer a textured surface on the
implants. Without your pictures it's hard to judge what I would recommend for
you. However these
general principles apply.

The incidence of contour irregularities when silicone gel implants are placed is about the same above or below the muscle. Some muscular implants are influenced by the vector of force generated when that muscle is exercise. In some patients this can push the implant and inferior direction causing bottoming out.

You have some very knowledgeable questions. The truth is that there is a give and take with each procedure. A consultation with a board certified plastic surgeon is the best way to figure out which procedure is the right one for you.It is hard to answer those questions without seeing you in person.

One of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons have a preference, the truth is that each approach has pros and cons:

Subglandular Augmentation (Under the Gland/Over the Muscle):



 ·      Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also relatively faster when compared to subpectoral augmentation. 

·      Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection). 

·      Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space. This can be mitigated by the use of a textured device. 

·      Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.



 



Subpectoral Augmentation:



 ·      Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade” or ride up. The upper hemisphere of the implant sits underneath the muscle (dual plane), while the lower pole sits below the breast tissue. This muscle release contributes much of the discomfort encountered postoperatively by patients. 

·      Subpectoral implants have a lower rate of capsular contracture. This mitigates the need for a textured device.  

·      Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

·      The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.



 

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. There is no replacement for an in person exam. A potential augmentation candidate may be better suited for one approach or the other.  As always, your board certified plastic surgeon can help guide you in your decision making process.