Subglandular Breast Implants for a thin woman will not cause any aesthetic issues. Is this true?

Question

My plastic surgeon (who has 40 years of experience with breast augmentation) has advised me that he rarely does submuscular/dualplane augmentation and that he prefers subglandular. He has assured me that despite the fact that I am thin (5'10 and 115 pounds), that a small implant (which will bring my A cup to a mid-sized/full B cup), will not cause any aesthetic issues such as rippling/deformities/ability to feel the implant/see the implant... True/false?

James N. Romanelli, MD, FACS · Answer

In the short term you may have excellent results as a thin woman with implants above the muscle, especially if the implant is not too large.  Long term is a different issue.  In my experience, subglandular implants are less likely to maintain a great cosmetic look long term, and are more likely to lead to rippling and contracture.  In my practice, more than 99% of implants are placed below the pectoral muscle.I know it must be difficult to hear different opinions.  Best of luck!

Joshua A. Greenwald, MD, FACS · Answer

In general, patients as thin as you generally fare better with submuscular augmentation in addition to enjoying the other benefits of SM augmentation (lower incidence of capsular contracture, no superior or medial rippling).   It seems like you are planning to use a modest implant and sounds like you have selected an experienced surgeon so you should do well.

Shahram Salemy, MD, FACS · Answer

This is a great question and I think your surgeon's experience is critical, but in general I personally prefer the submuscular pocket as it seems to work well for most patients.  But there are instances where a subglandular pocket can be appropriate and quite reasonable, in particular when using silicone implants or even the form stable highly cohesive gel breast implant.  It may be helpful to chat with your surgeon and discuss which type of implant he would plan on using.

Matthew Schulman, MD · Answer

We may all have slightly different opinions about this, but I find that there are several advantages to placing breast implants under the muscle - lower capsular contracture rate, more natural upper pole, less rippling, and overall lower complication rates.  There are very specific situations where a subglandular implant is better - competitive body builders for example.  This is a complex discussion, but most of us would agree that in thin individuals, placement below the muscle is best is the vast majority of cases. You may want to seek a second opinion.

Terrence Higgins, MD · Answer

I think it is never inappropriate to get a second opinion from another board certified plastic surgeon in your area.  This will be the best way to truly make an informed decision.  Both subglandular and sub muscular breast augmentations have there roles.  The determination about which is best for you is based on soft tissue/breast, ptosis/droop, and desired outcome.  Best of luck to you.

Kenneth R. Francis, MD, FACS · Answer

Dear O'Hare,If your plastic surgeon is certified by the American Board of Plastic Surgery, has 40 years of experience with breast implants, and has assured you that you will not have rippling or implant palpability, then go for it.  He/she is the only one that has examined you and evaluated your tissue characteristics.  However, as you have heard from others as well, this is not the usual course of treatment for a thin patient having breast augmentation.  Good luck!

David L. Cangello, MD, FACS · Answer

Hello and thank you for your question. It it is obviously not possible to address your specific case without seeing you in person, however I can make a few general comments regarding breast implant placement position. The first is that we know that rates of capsular contracture (hopefully your surgeon has discussed this with you) are lower when the implant is placed under the muscle as opposed to in the subglandular position. Furthermore, the less tissue you have to cover the implant (given your stated small breast size I'm assuming you don't have much) the potential for visible rippling can be greater with an implant placed in the subglandular position. In my practice, I rarely find an indication for subglandular placement of a breast implant.  I'm not saying that it's not acceptable to put the implant there, but I'm not sure there is any benefit to it, and perhaps there are some downsides as I've mentioned. You may want to seek a second opinion if you're not comfortable with your surgeon's opinion. Best of luck to you. Hope this helps.

Brooke R. Seckel, MD, FACS (retired) · Answer

Your surgeon may be correct and you may be able to achieve a nice result with a Sub-glandular breast implant.However be aware that your risk of capsular contracture or hardening of the implant is greater in the sub-glandular augmentation.  In addition problems with visibility of the edge of the implant and if using saline, visible rippling, are more common when the implant is placed on top of the muscle.There are many significant benefits to sub-muscular placement of a breast implant.  These are more and better coverage of the implant to avoid visibility of the implant and less risk of capsular contraction.If you have ptosis or sagging, if it is minimal, a biplanar approach allows for the implant to be placed beneath the muscle and the breasts to be redraped over the implant which can lessen the effect of mild sagging.

Subglandular Breast Implants for a thin woman will not cause any aesthetic issues. Is this true?

Answers (8)

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