Breast Augmentation Submuscular or Subfascial? Whats Best for Petite Slim Women?

hi im planning to get a breast augmentation im a petite women 5"2"white 105lbs (30" chest) i been seen various doctors and what really confuse me is one recomend me submuscular and other subfascial.i want very big implants 400 cc or more and with natural look. the one that recomended me subfascial told me submuscular gives a "snoopy effect" on nipple and it moves with muscle and he dont even like to practice submuscular .... is that result on all submuscular cases? im not sure whats best.

Doctor Answers 8

Sub muscular vs Sub Glandular placement

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

Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews


I prefer to place most of my implants in the submuscular plane. I find the long term results to be far better than the sufascial plane.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Breast Augmentation - Over or Under the Muscle

I place the majority of my breast implants under the muscle ( sub-pectoral). Although each patient needs an evaluation to ultimately decide which site will work best for them, most will opt for under the muscle after their consultation. There are multiple reasons why I prefer sub- muscular (especially for a patient with a petite frame) : under the muscle the implant feels more natural as it is covered by more of the patients own tissue; there is a more natural slope from chest wall to breast; less rippling of the implant ; there is less chance for heavy scarring around the implant. This scarring can lead to a firm hard feeling to the implant (capsular contracture).

Placing the implant above the muscle decreases post operative discomfort and avoids distortion of the implant by muscle contraction. These are some pros and cons. The best advice is to discuss your concerns with a board certified plastic surgeon. I hope this helps. Good luck  

John Noonan, MD (retired)
Albany Plastic Surgeon
5.0 out of 5 stars 1 review

Submuscular or Subfascial

 •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)

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.


The subfascial placement has advocates who feel it the advantages are similar to submuscular implants, without the issue of animation. Most surgeon's feel the subfascial position is not unlike above the muscle placement. 

Animation does occur to some extent with all submuscular implants. Most patients are not bothered. For a petite women getting a large implant, I would agree with the consultants advising submuscular placement. 

Thanks for your question, and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

BREAST IMPLANTS: under or over the muscle

Without an examination, it is hard to give you any specific answers, however placing breast implants under the muscle (Sub Muscular) gives a more natural, softer look. 

James E. Murphy, MD, FACS
Reno Plastic Surgeon
5.0 out of 5 stars 32 reviews

Will 400 cc implants look natural?

Without an examination or photo it is not practical to tell you what you would look like but usually with you height/weight I would think that 400cc would make you look relatively large.  The snoopy look happens after someone ages or their breasts sag after having a pregnancy.  It should not be the case with the intial placement of implants.

Submuscular or subfascial augment

Thank you for your question. Without a full examination, I can't give specific advice. However, I can offer some thoughts.

A submuscular implant does not always or even frequently create a snoopy effect. The majority of breast augmentations are done in a submuscular fashion, and most turn out quite well. The advantage of placing the implant beneath the muscle in someone thin like yourself is that there is more padding infront of the implant. This can create a more natural result and lead to less rippling.

It is possible to get a nice result with a subfascial augmentation, but this is a less common approach. My concern in your case would be implant visibility and a lack of tissue over the implant. Of course, your plastic surgeon is the only person that can make that determination.

Good luck with your augmentation.

Jeff Rockmore

Jeffrey Rockmore, MD
Albany Plastic Surgeon
4.9 out of 5 stars 67 reviews

Best Implant Placement for Petite Slim women

Petite Slim Women need good soft tissue cover for their implants. These are the pitfalls if there is not good soft tissue cover:

  • Visible implant wrinkling
  • Dropout of the breast base
  • An implant that looks like it is bolted on to the chest wall

Making sure you avoid these problems:

  • Use Silicon, it has thicker texture and feels more breast like
  • Elevate more than just the Pectoralis muscle, including the external oblique and Pectoralis Minor to provide thick tissue cover on the side chest wall

The issue of the "snoopy dog" appearance is not a real issue. The surgeon should able to position the implant correctly or do a breast lift if needed. See the post below about when you may need a lift and the video about implant wrinkling and soft tissue cover

Ricardo L. Rodriguez, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 94 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.