Which Breast Implant Placement is Least Likely to Cause Sagging?

There is solely no consensus.  #Sagging can occur due to many reasons.  Some include the #size of the breast and implant,  #weight of the breast and implant,  #gravity , #age and/or aging, #weight loss and weight gain.  #Tissue integrity (ie. some women are more prone to experience sagging due to weakness of their skin and breast #tissue at the fold).

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. Bottoming out is a possibility with either position.  As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits. Hope that this helps! Best wishes for a wonderful result!

There are a few concepts to clarify. Preventing the implant from sagging wont necessarily prevent the breast from sagging. In women who have significant volumes of breast tissue sagging of the gland (which can occur following lactation, weight gain and loss, or menopause) overlying an implant can produce the double bubble or "Snoopy" deformity.
That having been said, use of a submuscular placement (with postoperative pectoralis exercise restriction) and a textured implant are probably the best methods to minimize descent of the implant. Please be aware that textured impants are generally a less popular option for many reasons.

 Placement behind the muscles is the better option.  When the implant is placed in front of the muscle there is more risk of the skin stretching and sagging, as others have said, like a rock in sock.  Good luck with your surgery.

There are ways to prevent bottoming out of breasts (see video) Placing the breast implants behind the muscle can help. But, the size of the implant and placement on the chest wall are also very important.   In my opinion, all breast implants should be placed behind the muscle.  and there are two compelling reasons behind my opinion. First, radiologists have let us know that they can best image breast issue mammographically when an implant is in a subpectoral compared to a submammary position. Another compelling reason is aesthetic. The pectoralis major muscle serves as an additional layer of soft tissue coverage for the upper pole of the implant, and it tends to flatten the upper pole of the implant somewhat creating a very smooth and natural appearing contour to the upper pole. 

Hello,
"Under the pectoral muscle" breast implant placement usually lends more support and retards breast sagging, as long as really large breast implants are not used.

I do believe that the two methods have different long term outcomes. With subglandular augmentation only the breast tissue is utilized to hold the implant in it's proper position. In subpectoral or submuscular augmentation the muscle helps hold the implant in place.
But the reality is that the larger the implant is the more it will thin the overlying breast tissue thus weakening the support mechanism. So larger implants placed under the gland only will result in sooner and greater sagging as compared to submuscular augmentation. Nowadays, most plastic surgeons place the breast implants under the muscle to prevent capsular contracture.

There are many changes that may occur to the breast tissue and skin over an extended period of time. It is the weight of the implant against the breast tissue that causes laxity. When the implant is placed either above or below the muscle gravity, time and weight still exact their toll. The key to having a lasting result is an implant that is appropriately matched to the quality of your skin. If your skin is thin or atrophic then it will sag if the implant selected is too large.

I do not think it makes a difference which pocket you place implants in. Most submuscular implants are placed after the muscle is released along the lower border. Therefore the implants are really just subglandular in this position. A breast lift will help with sagging breasts but the pocket will not make a big difference.

The positioning of your breast implants - in front of or behind the muscle - has some bearing on the sagging or the stretching of your breast tissue over time. Typically having your implant behind the muscle will cause less tissue stretch. However, the important factor is the quality of your skin and breast tissue. If you have good skin tone and a smaller breast size, no matter where you place the implant you will have minimal sagging over time. If you have poor skin tone and a larger breast size, the implant will accelerate the sagging of your breasts which are now heavier due to the implant. Also, implant size is more of a factor than implant position. Having a larger implant size will cause more sagging. Discuss your concerns with your surgeon before making final decisions on your implant and positioning of your implant.