Would I be a candidate for subglandular implants? Also my surgeon said I would need an internal lift from nipple (Photo)

Hi, thank you for sharing your question. You are a good candidate for subglandular breast augmentation. The use of an internal mesh support is optional and can potentially provide better longterm results, however, they would be more applicable if you were undergoing a lift, which you do not need.

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

• Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster
when compared to subpectoral augmentation.

• Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

• Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

• Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

• Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

• Subpectoral implants have a lower rate of capsular contracture.


• Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

• The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

With regards to your specific question, it does not appear that you need a lift as your nipple position seems excellent. The larger the implant, the greater benefit a "behind the muscle" approach provides. As this maximizes the camouflage available to conceal the implant.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other. As always, your board certified plastic surgeon can help guide you in your decision making process

Hello, thank you for asking, you do not need any breast lift at the moment, just with the augmentation with implants you will look fantastic. Thank you.

Dear louiie25,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

The patient in the photo does not exhibit any sag to the breast. She is relatively lean. However there is no right or wrong in this question. For sure this patient is a candidate for a sub glandular implant but she is also a candidate for a sub muscular implant. There are pros and cons with each approach that should be thoroughly discussed with the patient at her consultation including differences in risks including capsular contracture with each technique. Expected results should be discussed, the accuracy of mammograms with implant positioning should be discussed, the potential of being able to feel the implant (this also depends on type of implant-gel versus saline) and the surgeon should be able to review with you not just the rationale for location but also the cons with other approaches and why the surgeon in their determination chose this particular method. I do not think there will be a significant difference based on implant size. Also remember that the chest muscle may require some fibers to be split to allow entry into this's under the muscle region and to correctly position the implant but do remember that the muscle heals. I am not sure what an internal nipple lift means or why it would be necessary to elevate the nipple in this particular individual.