Should Petite Woman Go Sub Glandular or Sub Muscular?

I have had one surgeon recommend silicone, sub muscular. Another suggested silicone sub glandular. His reason was that I have no fat, and not a very thick chest wall, meaning there won't be a discernible difference with either approach. I am 5'3" ! 107 lbs. He also said current data shows no difference in incidence of capsular contracture based on placement- even though that was widely believed for many years. I am considering 250-300cc.

Doctor Answers 19

In most patients, below muscle placement is ideal for breast implants.

In most patients, submuscular placement is best. This gives the most natural appearance and the implant is less visible. This is even more important in the slim patient. There are some situations where above muscle placement is better - competetive body builders or professional athletes. Obviously you news to discuss this with your surgeon because there are other considerations, but I suspect a submuscular silicone implant would be best bases on your brief description. You are correct that there is little difference in capsular contracture rate.

New York Plastic Surgeon
4.9 out of 5 stars 326 reviews

Sub muscular vs Sub Glandular placement

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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Position of Breast Implants?

Thank you for the question.

I  think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Always go submuscular to avoid capsular contraction

 I would always recommend going submusclar when possible because placing the implant subglandular increases the chances of capsular contracture by up to 50%. 

Usha Rajagopal, MD
San Francisco Plastic Surgeon
4.6 out of 5 stars 40 reviews

Subglandular vs submuscular

I recommend sub-muscular implant placement.  I really can't think of many reasons to recommend subglandular placement; there are few indications.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon
4.9 out of 5 stars 59 reviews

Should I go above or below the muscle

From the answers already provided, you're probably figuring out that the consensus that for a petite thin woman with very little breast tissue, the most optimal placement of a breast implant is under the muscle.  Definitely go with silicone gel since saline is almost guaranteed to ripple over time and will look much less natural on your thin frame.

I hope that helps!

Gregory A. Buford, MD, FACS
Denver Plastic Surgeon
4.9 out of 5 stars 42 reviews

Sub-muscular or sub-glandular for a petite woman with low body fat and thin chest wall?

In someone who is thin with little tissue, then I feel that it is even more important to place the prosthesis in a submuscular position. It is almost intuitive that the more covering to the prosthesis you have, the less chance for visualization, rippling and palpation. I have not performed a total subglandular augmentation in over a decade, and in the appropriate case, find the *biplanar* approach far more satisfactory in giving a natural appearing superior slope to the breast than a total subglandular placement. The advantages of submuscular augmentation far outweigh the small chance of implant movement with pectoral contraction and that is even less likely in someone with a very thin pectoral muscle. It is not unusual that after many years, subglandular augmentations need to be revised to a subpectoral position, with or without skin tightening because of changes that occur with the breast over the ensuing years. So, given the details you have shared, I would certainly suggest proceeding with a submuscular placement.

I have a case up that might provide some perspective given the patient's height, weight (5'2, 115lb) and very low body fat. The case is entitled "Dual Plane Breast Augmentation" and can be found within my "Before & After Photos" section. 

William F. DeLuca Jr, MD
Albany Plastic Surgeon
4.9 out of 5 stars 183 reviews

Should Petite Woman Go Sub Glandular or Sub Muscular?

!2 answers 11 for sub muscular, one against. You do the math! But in person evaluation can change everything. Best from MIAMI DR. Darryl J. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Submuscular Implants Generally More Natural

I definitely feel that implants placed below the muscle have a more natural appearance.  This is especially the case in a petite patient who has little breast tissue and a thin layer of subcutaneous fat.  I also feel that you will be happier with silicone than with saline.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Sub-glandular breast implants

Although there are many advantages of both approaches, I prefer sub-glandular Implants iN someone like you. When done correctly, they give a more natural result, especially with use of the arms. There is no difference in mammographic interpretation. After a few years, there is no difference in most other factors such as palpability and Rippling. Pick the surgeon you feel the most comfortable with.

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