Sub Glandular Vs Sub Muscular Implant for Better Cleavage?

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

Post-operative cleavage will depend on your pre-surgery cleavage. You have wide-set breasts, which means you'll probably continue to have wide-set breasts after surgery. However, while you may have a bit of improvement, it may not be as much as you want. Unfortunately, your surgeon can only do so much to give you cleavage before it looks abnormal, since the implants have to remain centred underneath your nipples.  

Thank you for this excellent question.  The amount of cleavage you get and how to achieve more cleavage requires a multi-factoral answer.  First of all, if you have plenty of cleavage now, then it really doesn't matter which pocket you put the implant in.  You won't loose that cleavage.  Secondly, your existing cleavage is directly related to where you pectoralis muscle inserts on your sternum.  If it inserts close, you have more cleavage.  If there is a wide separation between the right and left pec, then you have a wide cleavage.  Depending on the width of your chest, placement of your nipples, and depending of which profile of implant you choose (moderate plus or high profile), the wider the implant in general, the greater the cleavage.  Implants below the muscle stay softer and look better.  Implants above the muscle give you a chance of increasing your cleavage but at what cost. 

Wow, TMI.  As you can see, so many questions to answer.  Of course, the right answer here is to pick an excellent, experienced Board Certified plastic surgeon, and then allow him or her to do all the heavy work (the stuff above). 

There are many advantages to having your breast implants placed in a submuscular(subpectoral) position. It is easier to perform mammograms, there is a higher likelihood of breastfeeding and a lower incidence of capsular contracture (scar tissue). Also, your cleavage will look more natural with implants under the muscle.

Best wishes,

Dr.Bruno

Subglandular placement will give you more implant visibility, and may allow you to have the implant more medially which translates to a 'better' cleavage.  However, for ideal breast augmentation the implant should sit behind your breast.  If your breast naturally sits more to the side, trying to place an implant closer to the middle will make the natural breast tissue look like it's falling off the side of the implant.  That is not a nice look.  Your pictures show a certain space between your natural breasts.  That same width should be expected after your surgery.  For the 'optimal cleavage', a good support bra will be your best friend.

Sincerely,

Martin Jugenburg, MD