Is subglandular/over the muscle becoming more popular again? (Photos)

The doctor I am going with recommends going over the muscle. I don't have sagging or tons of of breast tissue, I'm a full 34A. I am 23, thin and wanting a full C. This doctor showed me lots of before/after overs that look great and on women with similar starting shapes/sizing than me. On top of this, I am a pretty serious weight lifter and he said my pecs are so developed it would be very difficult going under and cause too much upper pole projection.

Doctor Answers 14

Is subglandular/over the muscle becoming more popular again?

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Thank you for the question.  Yes, I think that there may be a trend where breast implants are being placed more so in the sub glandular position. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well. 

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  Given your body type, I would recommend that use of these sub muscular position for you. 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the pectoralis major muscle)  that can be seen with breast implants placed in the sub muscular position.   

Best wishes with your upcoming surgery.

Subglandular popular again?

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You bring up an interesting question. I have seen a slight increase in the number surgeons placing implants in the subglandular position. In the vast majority of cases, I still prefer to put implants under the muscle, and I think you would be an ideal candidate for a sub pectoral implants position. 

It's critical to choose a surgeon who is certified by the American Board of Plastic Surgery and has extensive experience with breast augmentation.  Check their before and after photos!


Dr. Gabbay

Joubin Gabbay, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 26 reviews

Going under or over the muscle

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I personally believe that there are more advantages to going under the muscle than over the muscle, especially if you are thin and dont have a lot of breast tissue. Most plastic surgeons typically place more implants under the muscle than over the muscle. I have not had any problems going under the muscle no matter how "developed" the pectoralis muscle is. In fact, in transgender patients (male to female) their muscles are typically larger and more developed than in most women and I have not had any problem going under the muscle.

Paul Wigoda, MD
Fort Lauderdale Plastic Surgeon
4.8 out of 5 stars 30 reviews

Subglandular Implants

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Many of us are now choosing subglandular implant placement rather than subpectoral in woman with your needs. With smaller chested, short chest wall patients, subpectoral implant placement still means lower pole of the impant is not covered by muscle when enlarging to a C size. If using the newer, fuller filled implants as we see with the newest Sientra over filled implants, these can be placed thru the axillary ( to hide the scar) route just under the breast tissue and over the muscle, and feel natural without ripples. These implants feel like breast tissue with no greater risk if capsules or " bottoming" out. The surgery is faster, less pain and without damage to the muscle. In body builders you don't get the " upward pull" sign as you do with implants place under the muscle. These breasts look and feel excellent without the severe bruins or pain usually experienced with subpectoral placement. Speak to your surgeon to see if you are a candidate and if he uses these newest implants.

Peter R. Neumann, MD
Roslyn Heights Plastic Surgeon
4.0 out of 5 stars 4 reviews

Sub glandular/over muscle breast implants

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Over the muscle gel implants can give a very natural contour and a little more lift effect. Also better in serious weight lifters.

In thin women, higher filled Sientra gels are a good choice.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations. 

Subglandular vs submuscular implant placement

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Thanks for the question.

There seems to be a small trend to place some implants subglandular vs submuscular.  I place most of my implants submuscular, but I generally use the subglandular placement in certain conditions:

Body builders, Very active individuals, many asymmetries, wide cleavage, droopy breasts and several others.

There are good and bad points to either placement.  You need to weigh all of your options and go fro several consultations to make your final decision.

Best of luck.

Dr T

Douglas Taranow, DO, FACOS
New York Plastic Surgeon
4.8 out of 5 stars 65 reviews

Implant pocket

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Implants can be placed above or below, but above in a very thin patient may result is early rippling and visibility of the implant, and smooth silicone are found to have  higher contracture rate above the muscle.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Subglandular breast augmentation

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This is a great question! Subglandular augmentation is not trending up. While subglandular augmentation is the textbook answer for body builders, I have performed submuscular augmentation in body builders without any issues. The problems with subglandular augmentation is that smaller breasted patients don't have good coverage over the implant, so the implant may be visible under the skin; risk of capsular contracture is higher; and the implant will put weight directly on the breast tissue, exacerbating breast sagging and nipple areolar spread. It may be right for you - just make sure you get all the information you need.

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.8 out of 5 stars 57 reviews

Implants over the muscle

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Most patients opt for the subpectoral augmentation to achieve a more natural appearance, lower risk of capsular contracture, etc.  Limited coverage of the implants in a very thin woman is another consideration.  You would need to be examined to assess the accuracy of the concept that your pectoralis muscles are too well developed and would create problems for a subpectoral approach.

Is subglandular/over the muscle becoming more popular again?

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Thank you for sharing your question and photographs.  There are both pros and cons to either subglandular or submuscular placement of implants but I do feel that most women, especially thin ones, benefit more form placement below your pectoralis.  Be sure to seek out a series of consultations so that you can make the best decision for your specific goals.  Best wishes.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 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.