I am considering having breast augmentation. Should I go for sub glans or sub muscular? (Photo)

I am considering breast augmentation. The PS I will be using has suggested silicone sub glans instead of sub muscular for a more natural look. Which placement is better? Can sub glans implants end up sagging?

Doctor Answers 27


Couple of issues.  First I suspect that your plastic surgeon is very likely referring to the dual plane pocket when she/he refers to the submuscular pocket.  Very few surgeons employ a completely submuscular pocket for breast augmentation and therefore we tend to get a bit "loose" with the terminology.  

Second - there are situations when the subglandular pocket is actually beneficial to the outcome and there are situations when the dual plane pocket offers little or on balance no benefit to the subglandular or subfascial pocket.  When used correctly the subglandular or subfascial implant pocket can help optimize the result for the patient.  Certainly when done incorrectly the subglandular pocket can increase complications.  

I would suggest that you have a follow up conversation with your surgeon.  If your surgeon is well qualified (a board certified plastic surgeon, member of the ASPS and ASAPS) and very experienced in breast augmentation, then you are likely getting good advice.  In general these on line straw polls can be more confusing than helpful.

Boston Plastic Surgeon
4.7 out of 5 stars 29 reviews

Submuscular implant placement is preferred

There will be many different opinions about the best placement of an implant.  I fee that the submuscular position has several advantages including better coverage over the implant, a more natural slope to the upper pole of the breast, statistically decreased incidence of capsular contracture, and  better visualization of the implant on a mammogram.  Others will argue that these advantages do not exist but I believe that the medical literature and my personal experience argue for submuscular placement.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Sub muscular or sub glandular breasts augmentation

Dear Leti,
  Thanks for submitting your picture. You appear to be a small A cup and consequently, breast augmentation will be very beneficial for you as far as your famininity , confidence and enjoying nicely fitting cloths and bathing suits. There are many issues associated with breasts augmentation : pocket placement ( your question ), implants size, implants shape, saline or silicone etc. It is not simple and you have to do your due diligence. Do not choose the surgeon by the technique but rather by the result and the total experience. Consult only with board certified plastic surgeons who perform their surgery in an accredited surgery center for your safety. Check the before and after pictures to make sure that they are numerous, consistent and you like them. Also check the reviews for positive patients experience. Once you have done that, meet the surgeons in person, ask your questions and assess how attentive are the doctors and staff to you and do the answers make sense to you. A very helpful thing for you will be to examine a patient who had the surgery, with her permission and ask her questions, because , only than you can realy have a feel for the quality of the result and the healing process. As far as my approach,  which was developed after being 27 years in practice and doing thosands of breasts augmentation surgeries, it is as follows : 1. I use almost exclusively , smooth, round moderate profile saline implants. 2. sub areola incision for implants insertion. 3. Sub muscular pocket only . 4. Teach my patients to do implants displacement massage for optimal result.
 I hope this helps. For more information you can contact me at the office.
              All the best,
                             Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews

I am considering having breast augmentation. Should I go for sub glans or sub muscular?

I recommend submuscular placement of implants for three reasons.

1. They look more natural as the pectoralis muscle gives a more natural slope in the upper part of the breast and not the bulging softball on the chest look of subglandular placement.
2. The muscle will separate the breast tissue from the implant for the majority of the implant so less tissue is hidden during mammograms (7-8% vs 23-25%).
3. There is less chance of capsular contracture or hardening of the implants when they are placed under the muscle.

The biggest drawback is the extra 2-3 weeks of healing as it feels like a pulled muscle on the chest. I believe this extra 2-3 weeks is worth the lifelong benefits from having them placed submuscularly. 

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Nothing natural about implants

and if you're having smooth round implants on top of the muscle, they often turn to 'rocks in socks' years down the road.  A shaped implant on top of the muscle?  That should be better BUT they don't move around like normal breasts.  If you can handle the muscle distortion that comes from under the muscle, there are many advantages to going under the muscle if using smooth round implants.  Ask your doctor for rationale behind recommendations and you may better understand the reasoning.  But in my experience, I get a lot more 'natural' look when using a 'dual plane' submuscular placement.  And my competition, who exclusively uses subglandular placements, has more less than desirable results beyond the initial recovery period because I do their second opinions.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Above or below the muscle

Thanks for your inquiry.  I see no good reason to place the implant above the muscle. Implants placed under the muscle have been shown to harden less and be less palpable and visible.  Good Luck. 

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 197 reviews

Implant pocket position

I prefer to place most implants under the muscle because it adds more soft tissue coverage especially in the upper pole. Best of luck.

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

Sub-pectoral vs. sub-glandular positioning of breast implants

I think the benefit of several decades of experience "proves" that positioning breast implants below the pectoralis muscle is the best way to go both short term and long term. I see no real advantages to positioning implants in the sub-glandular position and disagree with Dr. Setty about less painful (a very short term issue anyway) and a lift effect. Breast implants do not lift the breast up. They only "lift" them out. 
The key is to make sure the pectoralis muscle or its fascia does not cause problems in the lower pole of the breast. An adequate dual plane or split muscle technique must be done to avoid problems in the contour of the lower pole of the breast where the muscle or its fascia offers no advantages. In other words, if done properly, sub-pectoral positioning of the implant is clearly superior over sub-glandular positioning although I'm not convinced there is less capsule contracture with sub-pectoral positioning. I think (but can't prove) that this difference is because of using inframammary crease incisions rather than periareolar incisions. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

I am considering having breast augmentation. Should I go for sub glans or sub muscular?

The procedure that will give you an excellent and natural result is the dual plane subpectoral technique. You get the best of both the submuscular and the subglandular approaches. 

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

Sub muscular v. Sub mammary - why not both? #breastimplants

A nice approach is biplanar.  In this setting, the implant is sub muscular for approximately the top half and sub mammary for the bottom half.  The technique requires are more careful dissection, but you get the best of both worlds.

Mark D. Wigod, MD
Boise Plastic Surgeon
5.0 out of 5 stars 9 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.