Subglandular Silicone in Lean Athletes? (photo)

So, I just went to another consultation. This time the doctor was 100% adamant that I needed subglandular placement, explaining that unders would sit too high on my chest due to my slight ptosis. He said I definitely don't need a lift, and that any droopiness would be corrected by going over. I am worried about being so lean during competition that the implant would be noticeable. I am also worried about the slight stretch marks I have not being filled out enough.

Doctor Answers 11

Breast Augmentation for a Lean Athlete with Slight Ptosis

Your dilemma is one of the most common complaints for patients who are lean and athletic with a little glandular settling but not ptosis. This time your doctor provided you with advice and recommendations that I would agree with. What he probably did not provide  was an explanation why he recommended putting implant in  the subglandular pocket. I believe that in your case and based on the pictures shown, you do not need a breast lift  as your nipple position is not low enough to satisfy breast lifting with added scarring. The subglandular implantation will fill your breast tissue in front of the muscle and create a more cosmetically balanced appearance because you do have glandular settling and the implant will anchor the tissue in a better position but only if placed in front of the muscle. The disadvantage of subglandular positioning is that the implant is placed  one layer deep instead of two layers. You seem to be torn between one and two layers of covering  your implant. The advantage of putting it behind the muscle is that your doctor will place it two layers deep. However, your breast tissue has settled and to put the implant underneath the muscle, your nipple will be in a very low position due to glandular settling showing in the picture. The main disadvantage of putting it two layers deep under the muscle  is that it has less of a lifting effect on the breast tissue and over the years, 5-10 years from now,  your breasts will continue to slide off the position of the implant which stays in place due to submuscular positioning. The 5-10 year period may be shortened or lengthened depending on the type of skin you have, future pregnancies, if any, significant weight changes and existing tone and presence or absence of stretch marks in your skin of the breast. I feel for your dilemma and ultimately you have to make a compromise decision between subglandular and submuscular positioning of the implant. While you are considering your options, let's not forget that you do have very aesthetically pleasing chest shown in the picture provided. The implantation will enhance the aesthetic outcome  but no implant surgery is perfect on all counts. I hope this helps and best of luck.

Torrance Plastic Surgeon
4.4 out of 5 stars 8 reviews

Implants over the Muscle

Thank you for your photos.  You should consider a subglandular placement but it may look  noticeable at the top of your breasts.  Your breast are somewhat droopy and the implant will not give as much lift as your really need.  You will just have larger droopy breasts.  If you are in super shape then under the muscle would not be the answer because that strong pec muscle will move the implant in odd ways.  It is a tradeoff. What you are you willing to accept?

Dr. ES

Subglandular Breast Implants in Athletes

Without an exam, it is impossible to determine if the implant alone will correct your slight droop or if the stretch marks will be improved much. However, being an athlete is an absolute indication for subglandular rather than submuscular implants. The benefits of this far outweigh the problem of possible thin upper pole coverage, though it appears that you should have no problem anyway.


Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Subglandular Silicone in Lean Athletes? (photo)

This is one of the damn if you do and damn if you don't issues. If so athletic than the most common placement is above, because pectoral flexion causes the implant to displace laterally. In the sub glandular position the lateral displacement is less. But the edge of the implant can show. As for a lifting, I might consider a donut lift in your case. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Subglandular vs. Submuscular Implants

I really agree with you - I think subglandular implants look less natural as you can often see the "outline" of the implants.  No only that but there are other reasons to have submuscular implants - one of the most important is the decrease in capsular contracture risk (bad scar tissue forming around the implant).  I do not think implants in any plane can truly give you a breast lift - I do think you would like how a mastopexy or breast list would look on you - it would move your nipple up higher on your chest and give you a rounder appearing breast.  Best of luck!

K. Roxanne Grawe, MD
Columbus Plastic Surgeon
4.9 out of 5 stars 137 reviews

Subglandular Implants in athletes

Thanks for your question. The amount of ptosis (droop) is always very difficult to judge in photos, but with yours I am wondering if perhaps a lift procedure might be appropriate. It may also be that you are communicating to your physicians that you do not want a lift, to avoid the additional scarring that it would present-- which is not unreasonable. At any rate, with the configuration of your breasts (without a lift) I would think that a dual plane technique would be fine, and that would be under the muscle. I think that in general and especially for you, there would be value in seeking out several different opinions regarding the recommended approach. Good luck!

Matthew Concannon MD

Matthew Concannon, MD
Columbia Plastic Surgeon
4.6 out of 5 stars 21 reviews

Subglandular or Submuscular

While it is true that submuscular placement can cause the issue you stated from your second surgeon, I don't believe that it is the only way to correct your problem. If your breast really thin out before competitions, subglandular implants can be more visible and palpable and can have a  higher incidence of capsular contracture. All surgeons have individual biases. I might recommend that you consult with a few more surgeons to get a consensus on technique before choosing who to go with.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews

Implant placement

You should be specific about your training routine and the nature of your competition during your consultation as this may influence the placement decision. The majority of my implants are sub muscular, but sub glandular may offer some benefits for weightlifters, etc. Make sure to discuss your lifestyle, training and competition with your surgeon so they can help you make the best decision.

Best of luck.

Sarah A. Mess, MD
Columbia Plastic Surgeon
4.7 out of 5 stars 21 reviews

Implant placement

Every surgeon has their preference with respect to above the muscle, under the muscle, dual plane, subfascial etc etc.  In my opinion, if you have thin tissue, I prefer a dual plane technique to help camouflage your implant.  Please visit with a board certified PS to learn more about your options. Dr. Basu Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Subglandular Silicone Breast Augmentation in Lean Athletes?

Thank you for the question and picture. Although I cannot provide you with a precise enough recommendation regarding the need for breast lifting, I can tell you that sub glandular breast augmentation can be more problematic than sub muscular (dual plane)  augmentation. By now, I am sure that you are aware of the pros/cons of each breast implant position.  If not, reading previous posts on this forum, or viewing the attached link may be helpful to you.

 In my practice, in short, I would not proceed with sub glandular breast augmentation for you or the vast majority of patients I see.  The need for breast lifting, as mentioned before, will be best  evaluated  by in person examination and a full communication of your goals.

I hope this, and attached link, is helpful.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.