Submusular vs subglandular: Which placement stands the test of time, especially if you plan to breastfeed in the future? (photo)

Thank you for your question. There are pros and cons to both placements and really comes down to personal preference.Implants placed over the muscle have a
more rounded look, which some women feel looks less natural, however
women may prefer this look; it’s a matter of personal preference. Pros
for going over muscle include less post-operative discomfort due to the
muscle staying intact and lower recovery time. For patients with slight
sagging caused by excess skin or laxity, but not enough for a breast
lift, over the muscle may fill out the breast more as because the
implants lie closer to the skin. Cons include higher susceptibility to
rippling as there is less tissue covering the implant and the skin is
receptive to future stretch marks as the implants are only supported by
skin. There is also a higher rate of capsule contracture, which is scar
tissue that can form around the implant causing the breasts to harden.
If the patient has a breast lift in the future or concurrent with the
augmentation, there is also a slightly higher risk with regard to
maintaining blood flow to the nipple.
Below the muscle, submuscular placement
provides more coverage of the implant resulting in less rippling and
palpability of the implants. With this placement pros include, less
chance of getting capsular contracture and there is better mammogram
detection. With the dual-plane technique, implants are covered by both
the breast tissue and the pectoralis muscle, creating a more natural
look. Cons include a slightly longer recovery time due to post-operative
pain and comfort and breasts may appear to sit a bit high until the
muscle fully relaxes.For the majority of my patients, I recommend under the muscle placement with silicone implants for a more natural look, with a lower risk of complications. One of the few situations where I recommend going over the muscle, is if the patient is a body builder and competing in a lot of shows where the pectoralis muscle is flexed. In that case, the muscle is very active and one gets a lot of animation with the implant. For either placement, there are circumstances based on a patient’s anatomy that one may be more beneficial than the other so it is important to be examined by a plastic surgeon to make an informed decision.

In general, augmentations done under the muscle (dual plane) have a lower complication rate than over the muscle and tend to hold up better over time.