Subglandular vs. submuscular? High profile or moderate profile? (photos)

Question

I am 22 years old and have lost most the volume in my breasts after pregnancy. Prior to my daughter being born, I had perky 32D breasts with no complaints. Now, my nipples have changed significantly and lost all the volume in my upper pole. Would a high profile saline implant restore the fullness I am looking for and help lift them a little? Does the subglandular or submuscular placement help with that at all?

Larry S. Nichter, MD, MS, FACS · Answer

Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle. The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.Over the Muscle (sub-glandular) – Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  Based upon the photographs that you supplied, what I would assume is a photo of your ideal aesthetic result, and in the absence of a physical exam, I would venture to say that you would be a good candidate for a sub muscular implant (either saline or silicone - the choice is up to you) and a bilateral breast lift.  Most patients today will elect for a silicone gel implant because they tend to look and feel more natural than saline implants do and do much better than saline implants do long term.  Placing implants in the sub glandular position would be, in my opinion, a huge mistake because it will lead to a 'rock in a sock' appearance as you age, would not correct your breast droop, and would not provide you with the upper pole fullness that I believe you are looking for.  I would recommend that you schedule a consultation with a board-certified plastic surgeon who is well-experienced with breast augmentation and breast lift procedures.  At the time of this consultation your cosmetic surgery goals and concerns can be best addressed.  I hope you find this helpful and good luck!

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question and photos.  Unfortunately an augmentation alone will NOT lift your breasts.  To achieve the best result possible, I recommend that you consider a full breast lift with implants (if you want to increase the volume of your breasts).All the best,Dr. ResultsMiami, FL

Peter J. Capizzi, MD · Answer

My recommendation is under the muscle for any type of breast implant most often.  If you do not you will see your implant more at the upper pole.  You will need a lift or minilift at least.  Finally, high profile just means more projection and is a more narrow implant per a given volume...it does not mean it sits higher on the chest.  Seek a plastic surgeon that specializes in cosmetic breast surgery and implants as I do and have an exam, try on some sizers and see the shape you are interested in.

Adam J. Oppenheimer, MD, FACS · Answer

Sorry to be the bearer of bad news, but to get to your wish pic, a breast lift and sub muscular implants are the correct answer. Going with sub glandular implants to "fill out" the envelope is the wrong idea. You will be destined for a breast lift and pocket change in the future as the implants will continue to pull down your already moderate sized breasts. As an aside, your tummy is amazing for postpartum, even though your breasts did stretch and the nipples became enlarged. An amazing tummy after pregnancy is hard to come by, so you're lucky at least in that way!

Charles Galanis, MD · Answer

Thank you for the post and for the accompanying photos.  Based on the information provided, you would almost certainly require a breast lift (mastopexy) to restore your breast height as well as implant placement to restore your breast volume.  Submuscular implant placement is generally the more preferred method in the United States most likely for two principle reasons: (1) additional tissue coverage of the implant to yield as natural a contour as possible and (2) potentially decreased rate of capsular contracture under certain conditions.  As far as which profile to select, that will depend on two factors: what size you want to be and specifics about your anatomy. The higher profile implants have a narrower base.  So if you are looking at larger volumes, you will likely require a larger volume.  I recommend seeking out a board certified plastic surgeon in your area and letting him/her guide you through the process.  Good luck!

Jed H. Horowitz, MD, FACS · Answer

#Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle.  This tends to more common in Europe and South America. Also, saline implants are filled with salt water and are placed either in front or behind the pectoralis major muscle and breast tissue. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option,  #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding. In any case, your plastic surgeon will determine which placement is best for you.Your doctor will work with you to choose the best implant #shape and #implantprofile based on your goals and measurements. The #profile is determined by the amount of projection versus roundness that the patient desires, as well as the size of the implant and size of her chest. The profiles are usually described as high, moderate plus and moderate.

Steven J. Rottman, MD, FACS · Answer

Thank you for your question and photos. It is clear you need a lift (mastopexy) at the time of breast augmentation due to the considerable degree of droopiness (ptosis) present. I prefer to place implants in the submuscular position when performing an augmentation mastopexy. You need to have an in-person examination with a board certified plastic surgeon who commonly performs cosmetic breast surgery for specific details of the procedure. Ask to see a lot of before and after photos of their work on patients with similar breasts. Hope this helps and good luck.

Vincent N. Zubowicz, MD · Answer

The photograph demonstrates fairly significant ptosis of the breasts. In my opinion where breast augmentation is not accompanied by mastopexy sub glandular placement does a better job of camouflaging the ptosis. Almost all patients now are choosing silicone gel implants because of their natural feel.

H. Daniel Zegzula, MD · Answer

Thanks for your question and the
photos. I don't think a breast augmentation on its own would give you the
results you want. You're likely to see better results from a combined breast
augmentation and lift. This is a very common technique that's popular with
women who have been pregnant. When it comes to implant choice, most surgeons
and patients alike agree that silicone looks and feels more natural, but this
choice is ultimately up to you. Implant profile refers to the degree to which
an implant projects from the body; it's harder to advise you on that with
limited information, because it depends on the dimensions of your body. Please
schedule an in-person consultation with a board-certified plastic surgeon to
learn more. Best of luck to you!

Subglandular vs. submuscular? High profile or moderate profile? (photos)

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