Subglandular or Submuscular?

I have very minor pstosis however my surgeon who is highly credentialed, board certified, and 20 plus yrs experience, advised that I am still a decent candidate for implants without a lift. My question however is he said my implants will be placed submuslcar (behind the muscle). After researching more, I've read women with fuller breasts or more skin have a better result with subglandular (above muscle). My sternal pole measures 23 cm but my nipple still above my breast fold. 14 days b4 surgery!

Doctor Answers 15

Sub muscular vs Sub Glandular placement

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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

Above or Below implants?

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You really need to be seen in person to give you a true answer. If you need a lift, then you need a lift. If you are borderline on needing a lift, then I would suggest having your implants placed above the muscle. If you have them placed below the muscle without a lift, you may end up with the dreaded double-bubble deformity. Make sure yoru surgeon is experienced at breast surgery.

Sub muscular or Sub glandular Position for Breast Augmentation?

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Thank you for the question. Although I cannot provide you with precise advice, some general thoughts may be helpful to you in this regard.

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.  Also, the immediate recovery period may be  more comfortable  after sub glandular breast augmentation as compared to sub muscular breast augmentation surgery.

Best wishes with your upcoming surgery.

Implant placement

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Implant placement is determined by many factors - including surgeon preference.   I prefer a dual plane technique where the upper half to two third of the implant is under the muscle and the lower third of the implant is above the muscle.   I feel this helps to facilitate a more natural shape and does help to "lift" the breast up a bit more in cases of very mild sagging.   In the end, select a board certified PS with great before after photos.   I'm sure you will love your results!  Enjoy.

Dr. Basu

Houston, TX

Advantages of subglandular location are unproven, submuscular is usually preferred.

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There is no evidence that placing the implants above the muscle gives a better result.  You will hear some surgeons advocate a subglandular location as a better way to avoid a snoopy look, but this has never been proven.  This undesirable appearance relates to untreated breast sagging.  I personally prefer a submuscular implant placement, similar to the experienced surgeon you saw.  Sounds like he or she is pointing you in the right direction.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 62 reviews

Implants under the muscle (submuscular) or under the breast (subglandular)?

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Implant placement in any given patient is influenced by a multitude of factors. Some of the more important issues include initial breast elasticity, size, and shape, as well as location of the nipple in relation to the crease fold (infra-mammary crease).

The pectoralis muscle can help hide the upper pole of the implant in a thin patient or displace the implant in an athlete. In some patients, the placement of the implants either above or beneath the muscle will result in a pleasing result.

The advantage of consulting with your experienced, board certified plastic surgeon is that he (she) is seeking to provide you with the best possible outcome based upon your expectations and examination.  Before you have your surgery, ask if subglandular placement is an option for you.

Best Regards,

Douglas J. Raskin, MD
Colorado Springs Plastic Surgeon
4.9 out of 5 stars 69 reviews

Implant placement

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There are multiple decisions to be made in breast augmentation: implant type-saline or gel? pocket location- over or under the muscle? incision location-inframammary, periareolar, transaxillary? and finally size.


Subglandular implants can be an option if adequate soft tissue coverage is present. However, there is a higher risk of capsular contracture. In those patients having subglandular augmentation I would prefer to use a gel implant.


Your surgeon has had the benefit of examining you so I would trust his/her judgement. Good luck.

Ann F. Reilley, MD (retired)
Baton Rouge Plastic Surgeon

Submuscular or subglandular

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In most cases I prefer to place the implants submuscular. I have several reasons for this:1) lower incidence of capsular contracture, 2) less chance of rippling in the upper pole 3) less palpability, and  4) lower risk of symmastia.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews


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Thank you for the question. 

If you have enough tissue in the upper pole of your breasts subglandular placement is preferred because it does not violate your muscle unnecessarily. There is no benefit for going under the muscle. The breasts are naturally above the pectoralis muscle. Continued muscle contractions will push your implants down and out to the side. However if you have thin skin or minimal breast tissue and you need the extra tissue provided by the muscle to minimize the appearance of ripples or visibility of the upper part of the implants then go under the muscle. 

Best of luck ...

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

Subglandular or Submuscular?

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Hard to make a suggestion without photos. 

In a borderline situation like this, I would place the implants in the the submuscular (dual-plane) location, because the advantages outweigh the possible edge as to ptosis. I would trust your surgeon's judgement. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.