Which Implant Placement is Better for Tubular Breasts - Submuscular or Subglandular?

Doctor Answers 23

Breast Implant Placement in Tuberous Breasts

Regarding: "Which Implant Placement is Better for Tubular Breasts - Submuscular or Subglandular?"

Let's first understand WHAT happens in tuberous breasts (they look like roots or tubers). The breasts are literally bound by circumferential bands of fibers which prevent the breast from achieving its dome like appearance, the areola is usually enlarged with a varying degree of fullness due to fat herniation into it.

To correct this deformity, we usually enter the breast via an incision around the areola (which allows narrowing the areola if too large) and allows cutting and release of the constricting bands. Once the bands have been cut, the breast is like an umbrella which just began to open. It takes the fullness of the implant UNDER the breast (just like the umbrella slide being moved up to the highest point on the rail) to spread the released breast over the implant.

Breast implant placement depends on the particular woman. In women with LARGE tuberous breasts an implant MAY be placed under the breast gland. But in women with a small amount of breast tissue we prefer to put the implant under the muscle to cover the implant and avoid visible and palpable folds.

Dr. Peter Aldea

Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Breast implants under vs. over the muscle

The question will be answered differently by different surgeons. Those who prefer under the muscle will say under the muscle and those who do not will say subglandular. However most will agree that with thinner leaner patients under the muscle is better. With respect to tubular breasts the most important component is performing the necessary surgical procedures on the breast tissue and skin as needed.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Correction of tubular breasts

I generally prefer submuscular placement of implants, as that position gives more tissue coverage over the implant.  An implant alone will not correct a tubular breast shape--additional surgical maneuvers are necessary.  However, an implant will help to stretch the tight lower pole of a constricted tubular breast.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 42 reviews

Implant Position for Tubular Breast

Each surgeon may express a different preference for implant placement.

Generally, I prefer submuscular.

The key to success is the redraping and reshaping of the breast, using the implant to help expand the breast.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

Sub muscular vs Sub Glandular placement

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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Depends on your body

This depends on an examination by a board certified and experienced plastic surgeon. However, I have found that the submammary position is more common.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Which implant placement is better for tubular breasts - submuscular or subglandular?

Thank you for your question!   The standard procedure would be placement of an implant (or tissue expander, depending on the lower pole of your breast) as well as a circumareolar breast lift.  These modalities would correct the issues with tuberous breast: constricted breast at the inferior pole, via breast prosthetic; scoring of the tissue to release the bands; lowering the inframammary fold; correcting the herniation of breast tissue into the areolae; and decreasing the overall size of the areolae.  These are the hallmarks of tuberous breasts.  You could likely get great results with an implant and possible breast lift.  If one does truly have a tuberous/constructed breast, placement of the implant in the subglandular position will allow more effective and direct stretching of the tight inferior pole of the breast.

Consult with a plastic surgeon well-versed in breast surgery and discuss your goals and expectations.  S/he will then be able to examine and discuss the various options and assist you in deciding which decision os the right one for you, given your desires.  I would expect a very pleasing result for you!  Hope that this helps!  Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Treatment of Tubular Breasts

Thank you for the question.

Tuberous ( constricted) breasts are characterized by a wide spectrum of presentation including constriction of the breast base, glandular and skin hypoplasia (especially at the lower quadrants), mal-position of the infra-mammary fold, breast tissue herniation into the areola region and sometimes increased areola diameter.

Generally,  correction of tuberous breast anomalies involves breast augmentation with areola reduction / mastopexy procedure. The distance from the inframammary fold is increased (to create a more rounded out appearance). Proper implant positioning improves the distance (cleavage) between the breasts. The areola reduction helps to treat the pointed and "puffy" appearance of the areola.

In the most severe cases of tuberous breast, a more complete breast lift may also be necessary.  In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient and that revisionary surgery is more likely than in patients who do not present with tuberous (constricted) breasts.

Although every surgeon may have their own preference,  I would prefer to place the breast implants in the sub muscular (dual plane) position  if at all possible  to minimize risks associate with breast implants placed in the sub glandular position.

Probably more important than breast implant positioning,  is selection of a surgeon who has significant experience treating constricted/tuberous breasts.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast Implant Placement for Tubular Breasts

Tubular breasts are some of the most difficult and unpredictable breasts for breast augmentation. Placement of the breast implant over the must allows faster stretching of the breast tissue by the implant which will help to form the breast into a normal shape. the draw back is that breast skin will continue to stretch and patients get early sagging. Placement of the implant under the muscle is preferable in the long term, but it does take longer for the muscle and the breast skin to stretch out with the implant.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Best position for tubular breasts?

I hav e found the use of the dual plane (both under AND over) to be useful in the management of tubular or constricted breasts.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

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.