Subglandular Placement Bad Idea for me?

I went to a few consultations for a breast augmentation procedure to correct minor ptosis and enhance the shape and feel of my breasts. I am currently a 36B and mostly like the size although could go up to a C. I was recommended to do a nipple lift and small subglandular silicone implant through a periaerolar incision. I am concerned about the subglandular implant since I was warned that they are bound to droop over time? The PS said since it would be a small implant that it wouldn't be an issue

Doctor Answers 13

Lift at the same time as augmentation can be successful.

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A lift (mastopexy) can be successfully performed at the same time as an augmentation.  Some plastic surgeons will not combine these procedures, but those who are familiar and experienced with these techniques can give you the results that you want.

Ultimately YOU need to be the one who decides if you want to increase your breast size.  If you are happy with your breast size then you don't need any implant at all and can achieve your goals with a lift alone. An implant does help maintain fullness in the superior portion of the breast for a longer duration however.

The location of the implant (above or below the muscle) is mostly a choice for the surgeon and what they feel comfortable performing.  Placing the implant above the muscle does make further breast surgery riskier in the future because you have divided a significant amount of the blood supply to the breast.  For that reason I tend to prefer the submuscular position because any woman who has a lift will potentially become a candidate for another lift in the future.

Make sure your plastic surgeon is very familiar with performing both the lift and the augmentation together.

Ptosis and subglandular implants

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From your photos, it would seem that lifting alone would solve your problem, especially since you don't really seem to want to be larger.  If you do want to go up a cup size, a small subglandular implant would do the trick.  Implants, unless very large and heavy, don't sag, breast tissue does.

Michael Leff, MD (retired)
Bellevue Plastic Surgeon

Breast augmentation together with breast lift

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Your photos show stretched out areolae with the upper edge of the areolae at the level of the breast crease. I do not think you can correct that with a periareolar incision alone. Your case is not a simple one because of the drooping and stretched out areolae. You should see a few surgeons before deciding what to do. Take your time, do your homework and then it will be more likely that you will have a result you will be happy with.

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 Placement Bad Idea for me?

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Patients can receive almost as many recommendations as the number of plastic surgeons they consult. This doesn't mean most are off the mark, but it does make things confusing for the poor patient.

If you were in my office I would want to find out what concerns you most: the ptosis (droop), large areolas and/or lack of fullness.

 I believe that a prime requirement of what we plastic surgeons do is the avoidance of deformity and detectibility.

Therefore, the simplest and least scarring operation for you is a dual plane breast augmentation. This would allow an implant to be placed through an areolar or inframammary incision, partially under the muscle, and fill out your breast to the degree you desire. You would then be free to do your own lift with a nice bra.

You could add a mastopexy (breast lift). I am not a fan of the donut or Benelli mastopexy, which can flatten the breast and lead to very ugly areolar deformities. In your case I would do a lollipop or vertical mastopexy both to reduce the areolar size and raise the nipple position.

However, when you add the lift you add scars, complexity, expense, need for revision and detectibility.

Good luck!


Subglandular Breast Implants

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Although there is no concensus regarding the best placement of a breast implant, evidence from clinical studies and most surgeon's experience suggest that subglandular and subfascial implants lead to a higher risk of implant visibility, implant rippling, capsular contracture, excessive and unpredictable tissue stretch, and implant dropout causing the 'rock in sock' deformity.  Although partial retropectoral placement of breast implants (under the muscle) can lead to complications like dynamic implant mobility and irregularities in the lower pole of the breast, these complications are less severe and/or less frequent.

You do not have 'minor ptosis' and are not a candidate for a 'nipple lift'; you would certainly get an unsatisfactory result.  You will be best served with some variant of a full lift, either vertical, extended vertical, modified anchor, or traditional anchor.

I suggest checking the credentials of the surgeons you saw, and would suggest seeing a few more with excellent reputations in breast revision surgery.  Why revision surgery? Because those individuals are more adept and experienced in complex surgeries combining breast augmentation and breast lifting. As you would expect, they would be certified by the American Board of Plastic Surgery, and members of the American Society for Aesthetic Plastic Surgery.

Best of luck!

Implants & lift - which plane?

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With your situation and amount of soft tissue coverage, either plane will work.  They each have their pros & cons - which should be explained to you at a consultation - so it's not a "right" versus "wrong" answer for the subglandular vs. submuscular choice.  That being said, I usually use the dual-plane variation of the sub-pectoral plane.

 In my opinion, the most important part of the operation for you is the lift part, not the implant part!


All the best!

Subglandular can be an excellent choice in the right patient for lift and breast implant placement

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Thank you for your question and the photos. You will get different answers from different plastic surgeons about whether to go submuscular or subglandular.  Both can give excellent results.

A circumareolar approach with a small lift and reduction in the size of the areola seems reasonable.

I guess it boils down to your preference and the size of the "small" subglandular implant.  What size is considered small.  Anything more than a 250-275cc implant is going to add weight to the breast and have a tendency to drop overtime.

To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.

I hope this helps.

Subglandular Placement Bad Idea for me?

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For most of my patients I prefer a submuscular placement in order to mask the implant edges, but when someone comes in like you, with adequate cover for the implant,  I have no problem going over the muscle. It saves a lot of pain and eliminates any chance of distortion from muscle activity and looks very natural and the submuscular advantages are less important with yoour particular anatomy.

It's hard to get plastic surgeons to agree because we are all artists and all find differentways to get the results we are after. I personally like the idea of a periareolar lift for you. I do a lot of them and have no trouble with  flattening if a breast implant is used. And a properly done periareolar lift will not leave you looking baggy at the bottom. There are types of breasts where it shoud not be done, but it will work very well for you.

Another alternative that would work well for you if you do not want an implant would be to do a full lift. The breast shape after the lift will be more youthful and also have a smaller areola and then you never have to worry about replacing breast implants.

Subglandular placement can be a good idea

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I like what you surgeon has told you, and subglandular implants can be the best for some. With a loose skin envelope and a small implant there may be a better marriage of the implant and breast if the implant is not held back by the muscle. Best of luck, Peter Johnson, MD.

Options for breast implant placement

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There are a variety of opinions, but most would agree that under the muscle is better.  By the way, you really need to know what the limits are of a periareolar lift and if the result is what you want.  You actually look like you could benefit from more lift than just that.  An overextended periareolar lift looks flat in the front and baggy at the bottom of the breast.

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.