In general the benefits of submuscular placement are: Better superior (upper) coverage/hiding the implant in your cleavage where you will show them off the most Much lower rates of capsular contracture or scar tissue build up around the implant Most importantly, implants under the muscle do not interfere with your mammogram Dr. Feldman does not believe there to be any lasting benefit of subglandular (or sub fascial) placement. If your breasts are entirely below the muscle he will recommend a mastopexy (lift), not subglandular placement, to take advantage of the benefits mentioned above regarding submuscular implants. Submuscular implants look better, feel softer for longer and don’t interfere with mammograms, giving you the best chance at early breast cancer detection and highest cure rate should it develop. However, it’s not always that simple. Many times the bottom edge of the pectoralis major muscle ends higher than your natural breast crease. If you place the implant completely under the muscle it “rides high” and delivers a less than ideal aesthetic result, with your natural breast “falling off” the front of the implant. Therefore, to prevent that, Dr. Feldman frequently utilizes a dual plane placement. This means as much of the upper portion of the implant is under the muscle, for all the reasons listed above, but a small portion of the implant “peeks” out from under the muscle so the implant is nearly centered under the nipple. There are different degrees of dual plane release (I, II, III) but Dr. Feldman will do as little a release as possible to achieve an optimal aesthetic result, thereby leaving maximum muscle coverage. During your consult Dr. Feldman will discuss implant placement options, and during the exam he will determine where you pectoralis major muscle ends compared to your breast fold to estimate the level of dual plane release required to optimize your breast appearance.
I would recommend submuscular for a better long term result. With the modest size you are considering, I would also discuss shaped implants with your surgeon. They are likely to be the most durable option, hold the breast shape for longest, and have the lowest rate of contracture.
Sorry but this decision can onky be reached after a careful examination of the breast area. It sounds like your surgeon did that so if you don't trust his judgment, better get another consultation elsewhere. My personal preference in almost all patients is under the muscle with a dual plane approach.
I prefer placing implants beneath the muscle because long term, patients have better results...i.e. less risk of capsular contracture, palpability, and visibility. Remember that implants tend to thin out their overlying tissue and when placed in the sub glandular position, that can lead to increased palpability and visibility over time.
Subglandular implants, especially smooth surface implants have a higher capuslar contracture rate than subpectoral or dual plane implants. The capsular contracture data on textured implants is more equal between the two positions, but the textured implants often have more wrinkling and folding.
While your tissue thickness and firmness may be adequate now, it sometimes thins with time making palpability and rippling worse as you age.
Mammographic interference with visualizing breast tissue is less in the subpectoral position.
The major drawback to suppectoral placement is a distortion of the implant shape by the contraction of the muscle. This is usually mild and only noticeable without clothing.
Thank you for the question.
There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. The vast majority of breast implants placed in the "sub muscular" position are really being placed in the "dual plane" position ( partially sub muscular, partially sub glandular).
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. 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) they can be seen with breast implants placed in the sub muscular position.
I hope this, and the attached link, helps. Best wishes.