Is it ok to get Subglandular implant and lift?

I've seen 2 doctors that said opposite things so now I'm confused. Is it ok to get a lift with subglandular placed implants or is it better to go under the muscle? I hear it's not good to go subglandular an have a lift because of skin stretching and too much pressure on the incisions.

Doctor Answers 11

Subglandular Implant and Lift?

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Thank you for the excellent question. Every surgeon is different with their techniques and opinions on what is best for each patient. My recommendation is to consult with a board-certified plastic surgeon, preferably one who is member of the American Society of Plastic Surgeons. They will do a thorough evaluation and decide what procedures you would be a good candidate for. Be sure to address all your concerns, open communication is very important between you and your surgeon! Best of luck with your decision.

Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 65 reviews

Is it ok to get Subglandular implant and lift?

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Thank you for the question and pictures.
In my practice, I would offer you a breast augmentation with the breast implants placed in the sub muscular (dual plane) position. I think the advantages of placing the breast implants in this position are far greater than placing the breast implants in the sub glandular position.
This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in these sub muscular position.
I suggest you finding a well experienced board certified plastic surgeon who can show you lots of examples of his/her work.
I hope this and the link below help as you continue to do your research.
Best wishes

Pocket placement for lift/implant

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Thanks for your question.  The decision to place the implant under or over the muscle should primarily be decided based on the amount of existing breast tissue and thickness.  If you are a thin patient with less than 2 inches of breast tissue in the upper pole, it is not a great idea to put the implant over the muscle.  Thin patients will have more issues of palpability, wrinkling, and visibility of the implant in the upper breast with a subglandular placement.  It is perfectly safe to perform a lift at the same time, as long as the surgeon is cautious with their pocket dissection and takes care to preserve maximal blood flow to the breast.  I usually prefer a partial submuscular pocket (dual plane) in combination with my lift so that I have maximal coverage in the upper pole.  There is also a higher rate of capsule contracture with subglandular placement.  Good luck.  

Breast Lift

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The placement of the implant depends on the amount of breast tissue you have to cover the implant.  Every patient is an individual with different needs.  Both placements are acceptable under the right circumstances.  Best wishes!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Breast Lift and Augmentation

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I would always suggest putting breast implants behind the muscle. The result will be longer lasting, and your breasts will look and feel more natural. Behind the muscle implants also make breast imaging with mammograms  easier.
Find a plastic surgeon who can show you many, many photos of patients soon after surgery and a year or more after surgery.  Carefully check the credentials, education and training of your plastic surgeon and the medical staff that will be supporting you and our surgeon before, during and after surgery. Check the certifications of the facility where surgery will be performed. Be certain that you find a very well trained surgeon who truly listens to you and understands your goals

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Submuscular is most often the way to go.

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I think the advantages of placing the breast implants in this position are far greater than placing the breast implants in the sub glandular position.  Dual plane can be used and place the implants beneath the muscle.  Many studies support submuscular placement because it minimizes complications, contracture, deflation, folds, and increases ability for mammography. 

Peter J. Capizzi, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 93 reviews

Placement of implant

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Usually, in most women who need an augmentation and lift, I place the implant under the muscle for better coverage, more upper breast fullness, and help minimize the weight of the implant upon freshly lifted tissue. In those women who have very little tissue, I always place the implant behind the muscle. During your consultation, you surgeon can advise you what would be best for you.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 reviews

The risks of sub glandular augmentation with lift are very high

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Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's.  The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher.  The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement.  The blood supply surrounding the implant is worse so the risk of capsular contracture is higher.  The support for the implant is less so there is more long term shape abnormalities and sagging.  The look of a sub glandular implant is much less appealing than a sub muscular implant.  The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful.  There are no advantages to sub glandular implant placement.

Sub muscular dual plane placement is the modern way to do the surgery.  The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.

A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Breast lift with subglandular implants

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Hello and thank you for your question. This is a good question and may be somewhat controversial. I like subglandular silicone implants for breast augmentation. However when I am doing a lift as well I always go under the muscle as the blood supply to the nipple /areola complex is better this way. This does not mean it can't be done subglandular,  bur I am not willing to take that risk. Ask the surgeon who suggested subglandular about blood supply problems to the nipple/areola complex.
Peter Fisher M.D. 

Peter Fisher, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 58 reviews

Implant and lift

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I prefer to place them under the muscle to provide more soft tissue coverage. A lift can also then be performed. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.