Pole dancer seeking advice regarding subpectoral or subfascial breast implant placement. What would be the best option? (Photo)

Dear Joola_3,


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

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

• Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster
when compared to subpectoral augmentation.

• Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

• Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

• Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

• Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

• Subpectoral implants have a lower rate of capsular contracture.


• Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

• The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

With regards to your specific question, subglandular/subfascial placement might be preferred given the importance of to upper body strength to a dancer. There are inherent sacrifices as described above.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other. As always, your board certified plastic surgeon can help guide you in your decision making process.

The subfascial plane eliminates animation deformity and muscle weakness that can occur with dual plane under muscle placement, but it is usually limited to patients with a little bit of subcutaneous fat to provide coverage. However the Motiva implants recently approved in the U.S. seem to do well with less coverage especially if you aren't planning to have large implants.

When contemplating placement of breast implants, asking a person's day to day lifestyle and activity is the most important question. If you are someone who is physically active and does any kind of physical activity that involves upper body strength , we almost always suggest going on top of the muscle, sub facial. Going underneath the muscle you are at risk of implant displacement which is when the implant shifts or completely falls out of the pocket entirely.

Since you are a pole dancer and use the pectoralis major muscle, I recommend sub fascial or sub glandular. I also recommend small implants.

Best Wishes,

Gary Horndeski, M.D.

If you choose subfascial or subglandular you might consider the new Motiva Ergonomix implants. These have an extremely low published capsular contracture rate and are very natural. You might also consider transaxillary placement to avoid any scar on your breasts.

They can do light pole at 3 weeks and full speed by 5 to 6 weeks. Always best to to check with your surgeon's protocol. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

I urge you to find an experienced board certified plastic surgeon who routinely performs subfascial breast augmentation for patients such as you. This is my preferred placement and should be the only option for you. A moderate (classic or low profile) implant would be your best choice. Best of luck to you.

In my hands, I would do the submuscular placement to hide the implant edges. However, you can get the subfascial placement to avoid the animation movement. The coverage is less, but is still some.

It all depends on what type of implant you will choose (profile and firmness), Ive done several dual plane augmentation on pole dancers (with Motiva implants), and just the first 3 months were uncomfortable with several movements.
In case you dont want to have a dual plane augmentation, you can opt. for a subfascial hybrid augmentation (implant + fat transfer), this will "camouflage" the border of the implant, in case you don´t have enough tissue that covers the upper pole of the implant, hybrid will be a good option.
Hope this helped you