Breast Augmentation: Placement Advice?

I had a consultation for BA and decided to go w/ HP silicone implants (350 cc) w/ base diameter that matched my BWD. I am a 34B and my surgeon recommended subglandular placement. After reading the forums, it seems dual plane submuscular is a better choice. Could I please get some more advice on placement? Additional info: - ~20% body fat - engage in yoga & full body workouts - fine w/ roundness, prefer more medial cleavage - not fine w/ "fake" feel, noticeable movement, rippling or contraction

Doctor Answers 8

Implant Placement

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Good afternoon!

Congrats on your decision to undergo breast augmentation!  One of the keys to a great result is not only proper implant size and shape, but optimal placement for your body type.

It is difficult to say without an exam but in thinner athletic women who do not want an artificial look, placing the implant in the submuscular plane gives the most soft tissue coverage which minimizes rippling and gives you a more natural result. 

Be sure your PS is not only board certified

I hope this helps

Houston Plastic Surgeon
4.8 out of 5 stars 63 reviews

Submusuclar or subglandular implants

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Without an exam it is tough to say, but in general I prefer under the muscle for better soft tissue coverage of the implants.

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

Breast augmentation. Placement advice

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In general sub pectoral and dual planes do hide the upper pole of the implant better ie. less rippling and a more natural look especially with the HP implants. With respect to cleavage, sub pectoral placement may give a wider cleavage depending on the attachment of the muscle. You have to weigh out what is more important for you and discuss this with your PS.

Sydney Plastic Surgeon
5.0 out of 5 stars 143 reviews

Sub muscular or Sub glandular Position for Breast Augmentation?

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Thank you for the question.

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular 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.  Also, the immediate recovery period may be  more comfortable  after sub glandular breast augmentation as compared to sub muscular breast augmentation surgery.

Best wishes with your upcoming surgery.

Pocket Placement

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Hi Mia

There are many different pockets a breast implant can be placed in:

  • subglandular
  • subfascial
  • submuscular
  • dual plane: which has many different interpretations of what exactly it is.

All have pros and cons. If one pocket was the so called "best" then we would recommend it for all our patients. The key is you relaying your goals to your plastic surgeon and then together deciding on the "best" approach that suites you.

I hope this helps and good luck.

Implant Placement

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If you have told your potential PS that you don't want a fake look, I am mystified why he choose a HP implant over the muscle. That is the recipe for fake.

The practice of plastic surgery is slowly transforming itself into a field of evidence based medicine. That means we should provide treatment and care based on scientifically proven methods.  Unfortunately, many true plastic surgeons, and even more impostors that call themselves plastic surgeons (ENT, Dermatologist, OB-GYN, etc.) either do not care, or do not pay attention to the data, and perform outdated and inferior techniques.

Breast implants are best placed under the pectoralis muscle, unless a well informed, properly consented patient insists on subglandular placement.  Sub pectoral placement offers a decrease in short and long term complications, as well as facilitation of mammogram performance.

Get some other consultations with ABPS certified surgeons that are members of the ASAPS.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Above or below the muscle?

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Different plastic surgeons will give differing opinions depending on their preference and your exam. I very rarely place implants above the muscle because a large part of my practice is revision breast surgery and it has to do with a lot of site change operations to provide better upper and inner breast implant coverage. I personally believe that an implant in the partially under the muscle position (dual plane) will provide better implant coverage, a more natural look with the right implant and a longer lasting result. You are a thin woman and you level of activity should not influence placement as long as you allow yourself to heal under your board-certified plastic surgeon's care. I hope this helps.

Dr Edwards

5'6 Female into Heavy Exercise Will Sub Muscular Be Ok?

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Most surgeons in the US prefer submuscular placement. 

Advantages of under the muscle include:

  • implants more likely to stay soft
  • breasts look more natural (at least at rest)


  • fewer ripples, harder to feel the implant
  • mammography a bit better--less breast is hidden


Advantages of above the muscle

  • no animation (movement of implant when chest muscles are flexed)
  • less discomfort after surgery (just a couple of days)
  • less interference with cleavage possibilities

For weight lifters, body builders, the disadvantage of animation may trump the advantages of submuscular placement. Otherwise, absent some unusual anatomic situation most surgeons prefer submuscular placement.

As often happens, you will have to balance your priorities. Each of the two alternatives has pros and cons. All the best



Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.