Subglandular Vs Submuscular (W/preoperative Mild Ptosis)? (photo)

(yrs old, 2 children, breastfed for 2.5 years, 34C pre-pregnancy, 34B two years post-nursing, 110 lbs, 5"3. ) I will be having a BA in May, using a gel implant approximately 300-325cc. My goal is to fill the "sac", not to have high cleavage. My PS has advised me of the benefits and risks of each placement. I am concerned I may end up with the "double bubble". My PS believes that I have enough tissue in the upper pole to cover the implant. Thank You kindly.

Doctor Answers 6

Subglandular Vs Submuscular

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With occasional exceptions, my preference is for subpectoral placement of implants. 

There are a number of conditions that are described as double bubble, and they have different causes.

  • indentation on the breast implant caused by the breast fold when the implant is lower than the fold
  • indentation on the breast implant caused by the lower edge of the pectoral muscle
  • breast draping off the implant when a lift was needed but not done.

I don't see anything in the photos or narrative suggesting that you are at any particular high risk for any of the three causes noted here. 

Best wishes. 

Seattle Plastic Surgeon

Sub glandular vs sub muscular

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Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Breast Enhancement

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I would have to examine you but I agree with the other docs most implants are placed under the muscle now to help reduce the visibility and palpability of the implant, your pseudoptosis is something that is difficult to correct and may need a larger implant than suggested

Subglandular Vs Submuscular (W/preoperative Mild Ptosis)?

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Based upon the posted photos and statements I believe you need to better understand the operative choices. I would ONLY go sub muscle and I feel you need a larger size implant to "fill" the 'sac'. I might consider a lifting also. 

Subglandular Anatomical shaped implants.

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Thank you for your interesting question.

I think that your concerns related to "double-bubble" problem are correct. If implants are placed in a subglandular (sub-fascial) plane, you'll avoid this possible complication in a near future.

If you combine it wit placing anatomical-shaped cohesive gel implants -f.e. Natrelle (Allergan) Style 410MF120295 or 410MM125320- the final results will be very natural and pleasing. Round implants with volumes over 300cc, when placed in a subglandular plane, in thin/slim people, make the final results too obvious ("operated look").

Currently, FDA has approved the Style 410 -anatomical shaped implants- in the US, so your plastic surgeon can give tou more information about it.

In Europe (EU) we use this combination since 1999, with optimal results (compared with round subglandular implants).

Good luck!

Enrique Etxeberria, MD
Spain Plastic Surgeon

Subglandular Vs Submuscular Breast Augmentation

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I almost always place breast implants beneath the chest wall muscle. The advantages of submuscular placement are a more natural look, and significantly less risk for capsular contracture. So, with few exceptions I place the implants submuscular.

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.