What is the Difference Between Submuscular and Partial Submuscular Implants?

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

Doctor Answers 14

What is the Difference Between Submuscular and Partial Submuscular Implants?

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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

San Francisco Plastic Surgeon

Variations of submuscular implant placement

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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.)

Breast Augmentation- Submuscular Implants

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Submuscular breast implant placement is more often performed currently as a partial submuscular placement. The pectoralis muscle is detached from its attachment to the chest wall along the muscle's bottom edge, which is near the lower edge of the breast. The muscle is lifted off the chest, and a submuscular space is created, which is where the implant is placed. Partial submuscular placement implies that the bottom third of the implant rests below the lower edge of the muscle. This allows for the implant to fill the lower half of the breast in a natural manner while still filling the upper half appropriately.

Total submuscular placement is the original technique, which involved covering the implant's lower third with other muscles from the chest wall. Generally, this type of placement is not used often, and more so for breast reconstruction. The most common issue associated with total submuscular placement has been that the implant remains high on the chest wall, with the breast eventually descending below it, causing a drooping deformity. The split muscle method is similar to this and still involves total muscular coverage of the implant.

As far as animation, be aware that ANY submuscular placement can result in an animation deformity, but can be less severe with a partial submuscular placement.

Derek Lou, MD
Houston Plastic Surgeon

Sub-muscular Breast Augmentation in athletic person

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There is essentially no such thing as total sub-muscular breast augmentation. The breast implants are put partially sub-muscular. Some people simply refer to those placed in this position as “sub-muscular,” since none are totally below the muscle and it is easier to say. There is no way to prevent problems in an athletic person when the breast implant is placed under the muscle. For you, the implant needs to be above the muscle. I would also use a textured Silicone Implant, as I have found it remains soft and gives the most natural result.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

What is the Difference Between Submuscular and Partial Submuscular Implants?

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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 

Submuscular vs partial submuscular

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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.

Many technique variations available to placing implants under muscle

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Most prospective breast augmentation patients are familiar with the concepts of placing implants under or over the muscle. Each of these general approaches have a large number of variations that Plastic Surgeons consider and tailor to each patients unique needs. By far the most common approach is a "partially sub-muscular" or sub-pectoral positioning of the breast implants. Depending on the muscular anatomy, the pectoral muscle covers the upper 1/3 - 1/2 of the implant with the lowermost part of the implant covered by the breast tissue only. Another variation of this position is referred to a dual-plane technique. Totally sub-muscular implant locations are used much less commonly in elective breast augmentation surgery. This technique requires the adjacent muscles on the chest to be elevated along with pectoral muscle.

In order to decrease the dynamic shape changes to the breast that occurs with muscular contraction, slight variations in technique can be considered. Dual-plane, split muscle and sub-fascial techniques each have benefits and trade-offs.  The split muscle pocket is not popular with most Plastic Surgeons because of the added surgical trauma required and the more limited coverage provided by using only the upper portion of the pectoralis major muscle.

There is no one particular technique that is far superior to others or that is the best choice for all patients. Some shape and position change occurs during muscular contraction in all techniques where some or all of the muscle is used to camouflage and cover the implant.

Dr. Mosher

All are partially submuscular

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If  you are muscular, use silicone and put them under the breast, over the muscle. In cosmetic augmentation, all the implants are only partially covered by the muscle. People like to use fancy terms to make it seem as if they are better than the doc down the block.

Submuscular implants

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Nearly all submuscular implants are partial or split muscle situations. The terminology can be confuaing because some surgeons want to make patients think partial submuscular implant technique is something special. Total submuscular implants only usually occurs in reconstruction when implants are placed under the pectoralis, the serratus anterior, and the upper portion of the rectus abdominus muscles and most surgeons have drifted away from this technique. Any submuscular implant will have the possibility, even probability, of animation distortion. The only way to prevent this is to place the implant subglandular. You should weigh the pros and cons of this with your surgeon.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Partial Sub-muscular & Complete Sub-muscular Placement

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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.

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.