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

Each surgeon has his or her preferences based on experience and expertise. Subglandular placement will typically allow for more cleavage as it will provide increased implant visibility. However, patient selection is key and most patients will receive beautiful natural looking results with submuscular. Consult with 3 board certified plastic surgeons to understand your options, and choose the surgical plan/surgeon that best fits your goals/objectives.

Implant placement (over or under the muscle) has nothing to do with cleavage because the implant sits behind your breast, so that whatever cleavage (the distance between the breasts) you have now will be the same post surgery.  If you want to create more of a cleavage then you need good push up bras.  As for over vs under muscle implant placement, I prefer under the muscle.

Placing implants submuscularly can provide you with fullness and cleavage. There are limits as to how much cleavage you can create without causing problems but in my opinion, under the muscle is the better choice.   It is difficult to determine implant size and implant profile pre-operatively. Every surgeon utilizes a different technique to determine implant size. It is too much responsibility for the patient to decide on which type of implant should be used. After communicating with the patient, I use sizers intra-operatively to decide which implant profile and size to use to achieve the patient’s overall goals.

There are a number of compelling reasons for selecting subpectoral placement over submammary placement. The most significant is that fact that radiologists have indicated that it is easier to image breast tissue by means of mammography when the implant is subpectoral. The pec major also provides an additional layer of tissue to conceal breast implants in the 'social aspect' of the breasts - that part that is easily visible in swimsuits and lower-cut clothing. Additionally, the pec major is quite effective at flattening the upper pole of a breast implant so that a natural slope for the upper aspect of the breast is created.

Implants placed on top of the pec major tend to look very convex in the upper pole. The breast begins quite 'abruptly' in the upper aspect of the chest, and the appearance is therefore distinctly unnatural. Submammary implants are also more likely to have visible implant folds and ripples in the cleavage area. Another consideration is the fact that there is some evidence which suggests that the risk of capsular contracture may be lower with subpectoral implant placement. Even if the risk of contracture is the same, a mild contracture tends to be less noticeable and therefore less of a problem for the patient when the implants are in a subpectoral position.

Submammary placement may produce a reasonable result for fuller figured patients with larger starting breast volumes, as the larger amount of natural subcutaneous fat and breast tissue helps to conceal the implant contours. The problem is that as breasts age, they tend to deflate - especially in the upper pole. So what was adequate implant coverage in the cleavage area at age 27 may be inadequate coverage at age 37, and implant folds and ripples gradually become visible. So subpectoral placement is the best choice for both the short and long term.

 

Cleavage is more dependent on the bra and the shape of the chest rather than the implant position. . In this picture the sternum is more anterior than the ribs and the ribs flat surface is pointing away from the mid line so the implants will tend to be more lateral leaning and not medial leaning. The bra will make a bigger difference in the cleavage here.