Should I Go for Subgandular or Submuscular Breast Augmentation? Which Looks and Feels More Natural?

i am 1m55 and weigh 52kgs and will be going for a boob job in two weeks.i want to move from a B to C cup and my surgeon adviced me to go for a 260cc silicone implant above the muscles.i am a mother of 1 and breasfed for about 9 beast is not saggy but has only reduced in surgeon says i have a good anount of breast tissue and my current bra size is a european 75B(since i am a french speaking european).i am very confused.

Doctor Answers 7

Subglandular or Submuscular Breast Implants Can look Natural

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Thank you for your question.

Both Submuscular and Subglandular Breast Implants can look very natural.

Subglandular Breast Implants are more often used when there is a small amount of sagging after pregnancy that does not require a lift and in patients who have plenty of breast tissue. The Submuscular Breast Implants tend to stay higher and can accentuate the sag or cause a Snoopy Deformity in patients who have had children.

Submuscular Breast Implants produce better results when there is no sagging of the breast and in patients with small amounts of breast tissue.

Discuss your concerns with your doctor

Sub muscular vs Sub Glandular placement

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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

Sub Muscular Or Sub Glandular - Which One Looks And Feels More Natural?

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Thank you for this excellent question.  The easy answer is neither or both depending on how you look at it.  
The dual plane positioning of breast implants give the most natural appearance since they appear to be tear dropped in shape when viewed from the side.  Silicone implants give the most natural feel especially in the sub glandular position.  
The way to accomplish this seemingly impossible combination of look and feel with both sub glandular and sub muscular positioning at the same time is to place the implant first in the sub pectoral position, then go into the sub glandular space, release the pectoralis muscle from the multiple thin fibrous connection to the breast tissue, and it will move upward allowing the lower portion of the breast to be, in fact,sub glandular where the upper two-thirds to one-half of the implant is covered by the pectoralis muscle,therefore sub muscular .
The upper portion of the implant covered by the pectoralis gives a natural slope upward towards the collar bone which is the appearance of a natural breast.  The lower one half of the implant with no muscle covering it can bulge forward towards the lower portion of the breast giving a natural feel along with a natural appearance.
I believe this answers your question assuming that you and I agree as to what the word "natural" means.  

Implant placement

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Different surgeons have different techniques.  My preferenc is for a dual plane technique. Please see a board certified plastic surgeon for a consultation to learn more about your options.  

Dr. Basu

Houston, TX

Breast Implants Above or Under Pectoralis Muscle Placement?

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Thank you for the question.

I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  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.

Natural results with either subglandular or submuscular augmentation

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This always creates a lot of confusion-you are not alone.  If there was an absolute, significant advantage one way or the other, we would not even be discussing the 2 different options.  There are advantages and disadvantages with both under and over the muscle.  If the patient has enough tissue to cover the implant, then above the muscle is an option.  Keep in mind that the smaller the implant, the easier it is to cover the implant.  A 260cc size implant is pretty easy to cover.  So given your description, subglandular position is an option for you.  If you had laxity, the subglandular position would also be better.  Some surgeons and patients prefer submuscular position because there may be a lower rate of capsular contracture in the submuscular position (however not all plastic surgeons are convinced of this, myself included) and more breast tissue is visualized on mammogram (but there is no proven health benefit).  In addition there are disadvantages to under the muscle, such as movement of the implant with pectoralis muscle contraction (dynamic distortion) and a possibility of the implant drifting downward and outward over time.  In my office we discuss the pros and cons each way and figure out what is best for each patient.  There is no absolute right or wrong answer, it depends on the circumstances of the particular patient and sometimes purely patient preference.  Hope this helps.

Tracy M. Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Subglandular or submuscular breast augmentation

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If you have enough breast tissue to start with, a small implant like you describe may provide enough fullness to restore the breast shape that you lost after pregnancy and breast feeding.  However, I would recommend that your surgeon place the implant in either the submuscular or submusculofascial (subfascial) position as the subglandular position has the highest incidence of capsular contracture.

Leonard T. Yu, MD
Maui Plastic Surgeon

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.