Placing breast implants subpectoral Vs subglandular - which is more spacious?

Thank you for your question! Breast implant position is influenced, first and foremost, by your natural breast footprint or boundaries. The boundaries of the breast contain support structures that must not be injured during implant placement. Injury to these support structures increases the risk of the implant moving into the wrong position (symmastia, lateral malposition, inferior malposition etc). Submuscular implant positioning is more likely to restrict medialization of an implant than subglandular positioning. However, how much cleavage a person has is primarily determined by where that individual's breast footprint developed on their chest and is not very adjustable. Think of it like the foundation of a house.

Can't build cleavage, but the good news is, regardless of placement and shape/profile, you will have more volume or size. This fact will make it easier to create cleavage in clothes. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

The skin that covers your sternum is an important factor when it comes to cleavage. A very tight skin with minimal underlying tissue will be more challenging. Most times, I perform sub-pectoral augmentation because it provides a more natural appearance, a decreased rate of capsular contracture and allows for more accurate mammograms. When a patient has a wide sternum covered with thin skin, fat grafting can be used as an adjunct to the augmentation to camouflage, create cleavage and improve a wide space between the breast. Have an evaluation by a board certified plastic surgeon who can make accurate recommendations based on body type, type and volume of the desired implant, and the tissue available. Excessive dissection over the sternum by a non-experienced surgeon could also cause symmastia (uni-boob look) a deformity where breast implants cross the midline and appear to touch each other in the center, which is a difficult complication to correct. Good luck!

It’s not just the muscle that keeps implants far apart. It can also be the tight sterns skin. So going above the muscle might give better cleavage but not if the stern Al skin is tight

Dear watmoetje,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Placing breast implants subpectoral (under the chest muscle) generally provides more coverage and a more natural appearance, as the muscle helps conceal the edges of the implant. Subglandular (above the muscle) placement might offer more space, but it can be associated with a higher risk of visible rippling and a less natural look. The choice depends on factors like your anatomy, lifestyle, and desired outcome, so it’s crucial to discuss your preferences and concerns with a skilled plastic surgeon.

Both locations will place the implants behind the breast base. If your bases are far apart, your implants will be also.

Hi, watmoetje ! Firstly I thank you for your wise question. This was an issue I wanted to address for some time.
The pectoram muscle fibers attach to the sternum on midline, that is a natural limit of the submuscular pocket for the implant. We release the muscle to some level, but not all way up (that would be very unfunctional). This limits the implant to stay more laterally compared to subglandular pocket.
Sometimes too medial placement of the implant creates a good cleavage but ith the cost of a more unnatural look. So here the patient expectations are important. Submuscular placement have advantages and disadvantages, subglandular placement has also.
In patients with wide middle chest, it may be more beneficial to place subglandular to have better cleavage.

If you want more cleavage, subglandular approach is better; if you want more natural appearance , submuscular approach is better. Of course, a detailed examination is necessary.

There is no definite "yes" or "no' answer to your question. If your muscles are attached in such a way that they are widely spaced apart then you may get better cleavage by placing them above the muscle. However, depending on how the skin is with regard to your sternum will dictate how close the implants can be placed above the muscle. An in person evaluation by a board certified plastic surgeon is always the best way to get the recommendation that is uniquely for you based on your anatomy and surgical goals.