Breast Life or Subglandular With Too Much Sag (Age 24, 5'4, 145lbs)?

I am 24 years old and 5'4" 145lbs. I was told by my plastic surgeon that I have too much sag for submuscular placement but not enough to warrant a breast lift. He suggested subglandular placement and said I had more than ample breast tissue, however, I am a little hesitant after reading some negative things online about subglandular placement such as having a higher risk of bottoming out and capsular contracture. Do you think it will be better to just go for the lift or give subglandular a shot?

Doctor Answers 11

Breast Augmentation with or without Breast lift

I agree with my colleagues, it is difficult to assess if  you need a breast lift from your photos .  However, remember that regardless of whether the implant is placed above or below the  muscle, a breast augmentation without a breast lift will not elevate your nipples or make the breasts perkier.  If you want the breasts to sit higher on your chest you would need to consider one of several types of breast lift.  Best wishes.

San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Lift and implants

I often place implants below the muscle, and perform a dual plane approach.  The lift depends upon what your breasts look like on exam.  Hard to say from just the photo and the angle.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Implant Placement

Submammary and submuscular placement of breast implants may both be acceptable.  However, there are several good reasons to consider submuscular placement: 

1. Better support of the implant and less bottoming out of the implant over time as soft tissues stretch.

2. Mammography for breast cancer surveilance may be easier. 

3. Probable lower incidence of capsule contracture.

4.Lower incidence of palpability or feeling of implant. 

When considering augmentation/ mastopexy, it may be safer to place breast implants under the muscle to avoid disrupting the blood supply to the nipple. 

Stephen Delia, MD
Boston Plastic Surgeon
5.0 out of 5 stars 17 reviews

Implants and lift means under muscle

It is not a good idea to place the implants in front of the pectoralis muscle if performing a breast lift because of the need to preserve blood supply.

If a lift is performed in conjunction with breast implants the best results are obtained with the implants being placed under the muscle and the breast lifted to meet the implant position.

Mario Diana, MD
Plano Plastic Surgeon
4.5 out of 5 stars 28 reviews

Breast Implant Positioning (Sub Muscular or Sub Glandular)?

Thank you for the question.

It is not possible to give you precise advice without direct examination reviewing pictures. Generally, however I recommend sub muscular ( dual plane)  breast augmentation and mastopexy surgery for patients who have breast hypoplasia/ptosis (sagging). 

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 in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Implant Position


Your doctor is giving you old and unsubstantiated information regarding subglandular placement of implants negating the need for a breast lift in women with slightly saggy breasts.  As Dr. Rand has said, subglandular placement will create a 'dropped out' look to your breast once you have fully healed; any lifted appearance seen after subglandular placement is transient.

Your best course is partial subpectoral placement with the most appropriate lift to achieve an optimal appearance.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Breast Lift Or Subglandular Implants

There are several options open for patients that fit your description. But without a physical exam or at the very least a set of medical quality photos it would not be possible to give you a good answer for your particular case. Maybe you should see another 1-2 surgeons for consultation.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Submuscular vs subglandular breast implants??

First of all, ask any breast radiologist whether they would prefer breast implants to be over or under the muscle for mammographic breast cancer detection and they will say "Under!"  Secondly, implants above the muscle do not lift the breast, they just sag into the breast enveolpe and if they are big enough, they make you look matronly and old.  Doing a lift is your choice, but nothing other than the lift will give you a lifted look if your breast anatomy dictates the need for lifting.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Young Sagging Breasts - What Next?

I am not sure what the goals are with this patient. Let me try to help. Is the problem the shape (nipple position) or the size? If it is the shape, then a mastopexy (breast lift)  is indicated. If it is the size, then an implant is the way to go. If it is both, then both procedures can be done at the same time. In the submuscular placement, the implants are cradled under the pectoralis muscle, and do not descend with age. If you are genetically programmed for sagging breasts then your breasts will fall off of the hill. If you decide to go with a subglandular placement, on top of the muscle, the shape of the breast will not change , it will just be larger, and when your breasts sag, or drop, the implant will go with them. At your young age decide what you are trying to accomplish and remember that plastic Surgeons don't cure anything , we are maintenance surgeons.   

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

Implant or not

At 24 years old, your breasts are already too low.  The added weight of the implant will cause further descent and subglandular implants have a higher rate of capsular contracture.  Under NO circumstances should you have subglandular implants.  However, you are a candidate for a breast lift.  This can be done without a vertical scar and augmentation through a circumareola approach that would lift the nipple, the breast tissue and allow implant placement.  If you do not want an implant, the donut lift can also be done to lift your breast tissue and elevate the nipples.  You have to decide whether you wants implants or not.  You do not state your breast size and the decision is up to you.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 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.