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

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.

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

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

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!

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.

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.

Hi there-

Because a tubular breast shape is fundamentally a deficiency of skin and tissue, I believe a subpectoral placement is best.

Having said that, the only way to get accurate, responsible advice would be to find a good plastic surgeon you feel you like and can trust and visit for a consultation.

Only your plastic surgeon will know for sure which is better. Submuscular and Subglandular pockets each have their own advantages and disadvantages. The best position (in front of or behind the pectoralis major muscle) depends on the the breast being corrected.

A thin patient, with soft breast tissue, and a compliant muscle, will have a better result with placing the implant behind the muscle. On the other hand, if the muscle is thick, and the breast is large and fibrous, it is much easier to correct the tuberous shape by placing the implant in front of the muscle.

The tubular breast is challenging to correct. The restricted lower pole of the breast needs to be surgically expanded and the exapnsion maintained with an implant. The fold beneath the breast also needs to be lowered in most cases. I've found that dual-plane positioning is very helpful in these cases. The superior part of the implant is covered by muscle and the lower portion of the implant is in direct contact with the expanded lower breast pole. I generally do a peri-areolar mastopexy with Goretex suture to reduce the areolar diameter. For patient with a lot of the their own breast tissue, subglandular position also works well.

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.