What is the Difference Between Submuscular and Partial Submuscular Implants?

Question

What is the split muscle technique? And which is best for an athletic woman to prevent animation deformity?

Richard Baxter, MD · Answer

There are some important aspects to how breast implants are placed when under the muscle. Most implants are placed under for better coverage, primarily in the upper part of the breast. The pectoralis muscle is shaped like a Japanese fan, with the "handle" attaching to the upper arm and the edges attaching to the breast bone and the rib cage. The part that attaches to the ribs is higher than where the bottom of the breast is, so it is usually detached in order to let the implant sit lower where it is centered under the breast. The problem with this technique, often called "dual-plane" because part of the implant is under and part covered only by the breast, is that the part of the muscle that used to attach to the rib cage now attaches to the implant capsule where it can pull and cause what are called "animation deformities." The split muscle technique avoids this by covering the upper part of the implant but leaving the lower half behind it. That way you get coverage where it is needed but avoid animation problems. (Total under muscle coverage isn't practical for augmentation for a number of reasons.)

Austin Hayes, MD · Answer

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and hide rippling of the implant. Implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture).  Also, breast cancer screening with mammography gives better images of breast tissue when implants are placed under the muscle. Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. Although a small animation deformity will develop with submuscular implant placement, in my patients this is typically minimal and most women don't notice it at all. I believe that the pros of placing implants under the muscle outweigh a minor animation deformity that typically develops. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Jed H. Horowitz, MD, FACS · Answer

Each are beneficial according to implant type and placement. The possible benefits of #submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.This #sub-glandular #placement may allow for a shorter surgery and recovery with less discomfort. This placement can provide a slight “lift.” #Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.The #Dual-Plane placement method is a more current technique most often used when there is mild breast sag and the patient does not want a breast lift. The breast tissue and muscle are partially separated to allow the breast tissue to sit in a better position. Dual-plane can be discussed further during the consultation should breast sag be of concern.

Larry S. Nichter, MD, MS, FACS · Answer

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

William Bruno, MD · Answer

If you want to prevent an animation deformity (which is when the breast implant moves when the pectoral muscle contracts) you would want the implant located in a subglandular position (in front of the muscle). This location can make mammograms more difficult to interpret and have a slightly higher incidence of rippling, but if you're very athletic it is an option.

	I recommend consulting with a board certified plastic surgeon to discuss this in further detail and have a complete examination.

	Best wishes,

	Dr.Bruno

John Bradford Fisher, MD · Answer

While partial submuscular technique is prevailing at the present time, total submuscular augmentation is practiced among surgeons who are familiar with the applied anatomy of the upper abdominal muscular origins at the sixth rib which join to form a full muscle shelf composed of the rectus abdominis (six pack) the sheath of this muscle which originates from the external oblique (6th rib) and converge at the a point along the anterior axillary line with the Serratus Anterior to provide a 4 muscle bra.  This prevents displacement of the implant because all of this muscles are actually interwoven into a muscular "tent."  This concept was initially presented and developed in the early days of immediate breast reconstruction and gives a lasting natural look which can be controlled with isometric exercises.  I have been consistently performing this "living bra" procedure since the 1980's and it far exceeds its ability to provide a natural "integration" (blending) of any implant without the annoyance of implant drift into the arm pit (side boobies).The anatomy of the covering of the Rectus Abdominis should be well known to all plastic surgeons but the technique does not allow for rapid performance of the procedure especially in a climate where multiple implants are installed in a day and the price of "augmentation" continues to deteriorate making the procedure seem to patients to be all of the same.Distortion of submuscular implant comes from contraction of a single muscle the Pectoralis pushing the implant sideways off of the chest--if you contract your muscles with your original breast it will do the same thing--bunch up and drift in a lateral direction.The science of applied anatomy as it concerns implant displacement and placement unfortunately is left to opinion rather than fact--total submuscular is particularly important in thin patients, patients with a history of breast cancer (gives them a lifelong reconstruction) and for patients who still wish to feel the breast overlying the implant.  Submuscular implantation actually uses the patient's muscles as the augmentation and the implant is merely a "spacer- platform" for the muscular "tent."

Darryl J. Blinski, MD · Answer

Most of the previous experts have adequately addressed the definitions of location of breast implants. In each individual case I try to determine what is best for the situation. In your case as an athletic woman, I would recommend above placement due to deformation of the muscle action. Whether texture d or smooth is a decision between you and your chosen surgeon. Best of luck

Jack Peterson, MD · Answer

there are 3 main placement of implants.

	above the muscle (subglandular)

	implant is about 2/3 covered by chest wall muscle (subpectoral)  or

	implant is completely covered by  muscle including some upper abdominal tissue ( submuscular). This option is usually reserved for reconstructive surgery.

	Since you are athletic and do not want to have deformity with exercise, I would recommend the subglandular placement with a gel implant.

Steven Wallach, MD · Answer

Most surgeons who have stated they palce the implants submuscular usually release the muscle along the lower chest to allow the implant to sit appropriately in the pocket. But there are some surgeon who do not divide the muscle and the implants tend to sit too high.

Larry Fan, MD · Answer

During breast augmentation, breast implants are typically placed in three different locations/planes:

	(1) Partially under the pectoralis major muscle (also called "below the muscle," "partially below the muscle," partial retropectoral, partial subpectoral, partial submuscular, dual plane subpectoral, split muscle). In partial subpectoral placement, the breast implants are placed beneath the pectoralis muscle, and the lower attachments of the pectoralis muscle to the rib cage are released. The upper half to two thirds of the implants are covered by the muscle, while the bottom third of the implants are covered by breast tissue only. This allows the implants to be mostly protected by the overlying muscle while also being able to sit in a natural looking position that can fill out the lower pole of the breast. Partial subpectoral placement is generally the most common location for implant placement, although subglandular placement is also popular.

	(2) Completely under the pectoralis major muscle (also called "completely below the muscle," complete subpectoral placement, or total subpectoral placement). In complete subpectoral placement, the breast implants are placed beneath the pectoralis muscle. The attachments of the pectoralis muscle are generally left intact. The implants are completely covered by muscle. This allows the implants to be protected by the overlying muscle but causes a tendency for the implants to ride high. Complete subpectoral placement is generally reserved for patients with extremely thin tissues.

	(3) Above the pectoralis major muscle (also called "above the muscle" or subglandular placement). In subglandular placement, the breast implants are placed above the pectoralis muscle. The implants are covered by breast tissue.

	In general, animation deformity can occur anytime the implants are placed below the muscle (ie. partial or complete subpectoral placement). Animation deformity does not typically occur with subglandular placement.

	Each location for breast implant placement has its own advantages and disadvantages. I would consult with your local Board Certified Plastic Surgeon to discuss your options and goals.

	Warmest wishes,

	Larry Fan, MD

What is the Difference Between Submuscular and Partial Submuscular Implants?

Answers (16)

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