Would you recommend subglandular or dual-plane implants?

Subglandular can give nice, natural results. Gels are recommended to avoid rippling. Unfortunately, capsule contracture, while still low, can be slightly higher than submuscular.

Dual plane combines benefits of both.

Either way, if implant is placed under the breast without disrupting ducts, breast feeding should be possible. (Some women with or without implants do not make sufficient breast milk unrelated to the implants).

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

As a bodybuilder, I augment professional athletes frequently. I think for those people in whom the living is made by athletic performance, the implant can be placed above the muscle. Other patients will be happier longterm with submuscular (dual plane) placement. Realize that there is some tradeoff for submuscular placement including greater pain postoperatively and a diminution in strength. Although this reduction in strength is not noticed by most women, bodybuilders will be able to tell.
Submuscular or dual plane is a better choice for a number of reasons including reduced risk of capsular contracture and greater implant coverage. Tissue thinning and implant visibility tend to be more prominent with subglandular placement.
A property executed breast implant surgery should have no impact on breast feeding as the ducts should not be disturbed.

Hello darling,

The position depends on the results you wanna get and what the doctor thinks you need.
I recommend you to have this conversation with him/her.

Hope this helps and best of lucks.

Dr. Luis Mejia.

Deepest tolerable beneficial layer is best for natural proportional breast augmentation. Computerized 3 dimensional imaging can help visualize possible results. Trying on the proposed implants with a tight bra also helps. Good luck...

Thank you for sharing your question. Going underneath the muscle provides many advantages - increased implant coverage using your own muscle and breast tissue, a more natural look and feel, off-loading some of the weight of the implant from your breast skin, lowered capsular contracture risk, and mammogram benefits by separating the implant from your breast tissue. Hope this helps.

Thank you for your question. Having been in practice for over 25 years, performed over 4,000 breast surgeries, and have a practice that is dedicated to revisionary breast surgery, I have some perspective. First, subglandular placement is much easier for the surgeon and has NOTHING to do with the way we are taught. Breast augmentation is a very straight forward procedure for any surgeon above or below the muscle. Although subglandular breast augmentation can result in a nice result, it does have a much higher rate of capsular contracture and long-term complications. I often see "slide-down" of the entire breast complex down the chest wall over time giving a very poor cosmetic outcome. Also, I see significantly more wrinkling and rippling. The disconnection between the breast tissue and the pec major muscle disrupts any support to the breast. Please look at my revision gallery under "long-term changes associated with subglandular placement of implants". I strongly recommend to my patients to have dual plane (subpectoral) placement of their implants. Best wishes to you.

Dear ninamb0520,
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. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I was "taught" to place implants both behind the muscle and behind the breast depending upon what was best. For most women with minimal tissue, going behind the muscle gives better coverage, less rippling or edge look, and gives nice upper breast fullness. If you have minimal tissue, silicone implants will feel an look better. Implants are still placed behind the breasts, so breast feeding is still possible in most women. Going behind the muscle does help minimize the risk of capsule formation.

Dear ninamb0520,

The old dictum that over the muscle breast augmentation leads to greater capsular contracture rates is currently being challenged, particularly by clinical work being done in Canada. Implant technological advances, such as texturing and gel cohesivity, along with "no touch" techniques may be responsible for this, as well as, decreased rippling rates. However, it is not yet universally accepted that this will be the outcome. Be sure to have the BIA-ALCL discussion with your American Board of Plastic Surgery board certified PS before choosing a textured breast implant. From a medicolegal standpoint ANY surgery on the breast can affect breastfeeding ability. Good luck!

Thank you for your very astute question. Going over or under a muscle depends on many factors including internal breast lift dimensions and lifestyle. Last but certainly not least size of the implant matters. It is best to have a virtual consultation to discuss what is the best option for your particular needs anatomically and otherwise. It’s not all over Or under :).