I do serious pole dancing. I'm scared about getting under the muscle implants. Any thoughts/ experiences w/ subglandular?(photo)

I'm a 34 b now but the upper pole of my breasts are quite "deflated" after gaining and losing 20 pounds. I would love "natural" looking DDs with more fullness / cleavage in the upper pole. The surgeons I have talked to thus far are very anti the sub glandular approach. I am nervous about the "dual plane" or under the muscle approach because of heavily I use my upper body- think supporting my entire body weight using one forearm or climbing a 10 foot pole via only pull-ups.

Doctor Answers 13

You can find a surgeon that will go above the muscle for you

as you have legitimate reasons to do so.  In my practice, I always recommend shaped textured implants above the muscle to help offset the increased risk for contractures and more durability over time (avoids the rock in the sock look).  If you want to pole dance and are going to be using your arms to hold yourself up, I would have no problems putting your implants above the muscle.  As for those 'subfascial' placements, you get a rag tag of remnants of the fascia and whenever I do subglandular, I am always trying to preserve the fascia with the overlying breast tissue... but its never a clean plane as suggested by others.

Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Implants under the muscle

You can choose to have your implants under or over the muscle.  Generally the submuscular plane is recommend to prevent encapsulation and for a more natural look.  It would be best to examine your breasts in person to make final recommendations but it is definitely your choice to go under or over.  Best of luck to you

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.7 out of 5 stars 31 reviews

Pole dancing, excessive arm use and breast implants

The problem with excessive use of the arms after breast augmentation is the formation of a breast capsule.  It does not really matter if its over or under the muscle.   You must remember when an implant is placed either above or below the muscle a thin layer of scar forms around the implant.  This scar is of course attached to the muscle either above or below it.  The scar is delicate and highly vascularized shortly after surgery.  It can be easily torn if an individual is very active with her new implants.  Rapid contraction of the pectoralis muscle can tear the thin and delicate capsule.  This creates bleeding and subsequent scar formation.  Over time this scar tissue becomes more resilient to injury but never completely impervious to injury.  That's why doing very active arm exercises is risky for the healing of breast implants. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 79 reviews

Breast Augmentation Questions

Hello,Subpectoral, dual plane placement of implants works very well for most athletic persons.  However, if you were to get subglandular implants, my preference would be highly cohesive, form stable, anatomically shaped devices; this would minimize the risks of rippling, implant palpability, implant visibility, and capsular contracture, all of which is more common in the subglandular position.As for your desired size, 'natural' and DD don't coexist. You will look augmented at that size. So make a choice. Finally, regardless of the size, your nipple position will be suboptimal.  Only a breast lift can improve that. Go visit a few ABPS certified and ASAPS member surgeons.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Subfascial breast augmentation

you are the ideal candidate to have a breast augmentation but under the fascia of the pectoralis muscle. This will give you the best of both worlds, you will have implant coverage with the fashion but won't have the animation/dancing of the implants that is caused by placing implants under the muscle. This is a very common technique that was described the by Brazilian plastic surgeons and gives a very nice results without the downsides of placing the implant under the muscle. I commonly performed this in my practice and preferred to all other types of breast augmentation. 

Subglandular Breast Augmentation

There are pros and cons between the two different placements.  To summarize, the subglandular placement does prevent the animation deformity, where the implants moves with muscle contraction, but that tends to be the main advantage.  The disadvantage is many and include rippling, implant palpability, capsular contracture (implant/scar tissue hardening).  The main disadvantage of subpectoral placement is the exact opposite, animation deformity.  The benefits are many which is why most plastic surgeons would recommend subpectoral/dual plane augmentation.
Hope that summarizes it well.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 71 reviews

Submuscular vs. Subglandular Implants

You have so little soft tissue thickness that implants of the size you need on top of the muscle will likely look like two large grapefruit halves under your skin. Some patients want that look. But if you want a more aesthetic and feminine appearance the textured implants under the muscle with a dual plane positioning done by an artistic and experienced surgeon will be best by far, even with your pole dancing.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Over versus under?

Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a more narrow cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

I do serious pole dancing. I'm scared about getting under the muscle implants. Any thoughts/ experiences w/ subglandular?

I agree with the other surgeons that you have seen that there is a serious risk placing the implants beneath the breast.  You want a large size implant and the risk of capsular contracture or hardening of the implant certainly goes up with larger implants and placing implants under the breast on top of the muscle.A properly done dual plane 2 or 3 breast augmentation can provide the protection of the muscle with much less isk of animation deformity.

The right size for you

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants:

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.