Subglandular of Submuscular Placement if Volume Loss From Breast Feeding?

After breastfeeding I have lost fullness on top. I want a very natural result. I saw a PS who thought I should have subglandular silicone. After researching I have seen most PS prefer submuscular. Opinions?

Doctor Answers 8

Subglandular of Submuscular Placement if Volume Loss From Breast Feeding?

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Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement.

Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.

Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.

Hope that this helps! Best wishes for a wonderful result!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breast implants above vs. below the muscle

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Because implants do not blend in well with surrounding tissues at their edges the usual recommendation is to place the implants under the muscle for those who have very little body fat or breast tissue to start with. The goal is to maximize the amount of tissue between the edge of the implant & the outside world/eye. The muscle we refer to is the pectoralis major whose lower border only reaches to the nipple or above the nipple in women. Thus only somewhere between 30 & 60% of the implant ends up being covered by muscle. There are pros and cons to both above and below the muscle placement of breast implants. For example in older women, whose breasts sag and do not want the scars that come with a breast lifting surgery, the breast tissue can migrate downward and away from the implant creating a double breast appearance if the implants are placed under the muscle. Each patient is different and there is no one size fits all approach hence the need to see a plastic surgeon face to face in counsultation before having any cosmetic surgery.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Subglandular vs. Submuscular placement of breast implants

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I don't usually recommend sub-glandular (over the muscle) placement.   Do your research regarding the surgeons you visit - make sure to choose a surgeon who is certified by the American Board of Plastic Surgery (not cosmetic surgery) and a member of the American Society of Plastic Surgeons.  From here, you know you are selecting from qualified surgeons.  Most board certified plastic surgeons would suggest sub-muscular placement for better long term results.

Submuscular vs Subglandualr breast implants

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Submuscular placement of implants generally imparts less risk for future capsular contracture and visible rippling in the upper pole of the breast where the tissue is thin.  There are cases where subglandular placement may be preferred due to anatomic presentation. As such it is best that you seek the advice of an experienced Plastic Surgeon who can guide you after an examination.

Pedy Ganchi, MD
Ridgewood Plastic Surgeon
4.9 out of 5 stars 97 reviews

Supectoral or Subglandular implantr placement

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Without photos or the ability to examine you personally the answers anyone here can give you will be a bit more generalized.  When we say "subpectoral" you must understand that the muscle we place the implant under will not cover the entire implant.  It is a diagonal muscle that will cover the upper and inner aspects of the implant.  The lower edge that originates from the rib is usually cut to allow better positioning of the implant in the lower inner aspect of the breast.  The cut edge can be freed from the breast tissue to varying degrees to create what is known as a dual plane dissection.  The muscle coverage over the upper breast adds softness to the upper aspect of the breast.  Putting the implant under the muscle preserves most of  the blood supply from the muscle into the breast which will be important should you need a lifting procedure either now or in the future.  For this reason I feel that a submuscular placement has better longevity over decades.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Subglandular Vs Submuscular Implants

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When I first started performing augmentations virtually all implants were placed subglandular (by almost all plastic surgeons).  I, and most other plastic surgeons, now place almost all of my implants below the muscle.  There are several reasons.  Breasts are usually softer and more naturally appearing and feeling after submuscular augmentation.  I feel that there is also a bit less interference with mammogram interpretation.  The downsides are more initial post-op pain and a greater tendency for the implants to sit a bit high.  After a thorough discussion during their consultation, almost all of my patients elect submuscular placement.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Breast augmentation after breast feeding

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The issue of submuscular augmentation comes up frequently, and though most will have advantages from a submuscular implant, a few will not. Consider a breast which has a fairly loose skin envelop after breast feeding, and the goal is a more modest fill. If the implant is held under the muscle and not full enough to expand the skin envelop there will be a poor marriage between the breast and the implant, and they may not blend and flow together as one. In this instance subglandular is better, and the gel will win out over saline.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Subglandular vs Submuscular Breast Implant Placement

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Breast implants can either be subglandular, completely subpectoral, or partially subpectoral. If an implant is placed subglandular, this implies the implant is below the breast gland, but above the pectoralis muscle. With this location there is less risk of "animation deformity" (meaning distortion of the implant with pectoralis contraction) but slightly greater risk of capsular contracture. A capsular contracture is thick scar tissue which forms around the breast implant. Subglandular location should be avoided in patients with thin breast tissue due to risk of seeing implant edges and rippling through the skin. A completely submuscular location will cover the entire implant. With this approach, the risk of capsular contracture is less, but animation deformity is greater. With a "partial subpectoral" or dual plane approach, the upper portion of the implant is covered by muscle, and the lower portion is covered by breast gland. This has the advantage of decreased capsular contracture rates vs subglandular implants, and has less of a risk of animation deformity vs an implant completely covered by muscle. To decide which is best for you, I advise a consultation with an experienced plastic surgeon.


Good Luck

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 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.