Submuscular vs. Subglandular - Which is Better?

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

This is a good question as the majority of patient that wish
to have a breast augmentation desire a result that is going to feel and look
natural.



In the United States the vast majority of breast
augmentations are performed under the muscle.
However there are certain situations where the implant is placed over
the muscle. The benefits of placing the
implant below the muscle:1.More natural feel2.More natural appearance3.Less visibility of the implant4.Placing the implant below the muscle also
decrease the chance that the patient will form scar tissue around the implant.5.Less chance of having visible rippling from the
implant.



It is important to see your board certified
plastic surgeon to help guide you to an implant that will give you an
aesthetically pleasing breast.

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and hide rippling of the implant. Implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture).  Also, breast cancer screening with mammography gives better images of breast tissue when implants are placed under the muscle. Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. Although a small animation deformity will develop with submuscular implant placement, in my patients this is typically minimal and most women don't notice it at all. I believe that the pros of placing implants under the muscle outweigh a minor animation deformity that typically develops. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Thank you for your question. The pectoralis major muscle does not 'die' with submuscular placement; it may stretch and thin out a bit, but it remains very much living and functional. I may recommend the subglandular placement if the patient is very fit and has a very active pectoralis muscle. Otherwise, while subglandular was the original breast implant placement in the 1980's, it has somewhat fallen out of favor today. I place the most breast implants submuscular today among breast augmentations I perform.Good luck, and have a look at the web reference I have provided to my website. It explains in detail the three different breast implant placements.

Implant placement relative to the pectoralis major
muscle continues to be a source of controversy. Although the majority of
plastic surgeons prefer submuscular placement there is still a large group of
plastic surgeons who feel strongly about subglandular placement. Each group can
make convincing arguments regarding their position of choice. It’s safe to say
both approaches have advantages and disadvantages.

In the context of these discussions we feel that every
patient needs to be considered individually. Each patient has unique anatomic
findings that effect the decision to place the implant under or over the
muscle. The aesthetic goals of the patient are equally important and have a
significant impact on the decision as well. The vast majority of patients are
striving for larger breasts with a natural look. They want balance, harmony,
and proportion with the surrounding structures.

The majority of breast implants are placed in a
submuscular position. There are several advantages to this approach. These include
more soft tissue coverage which results in fewer visible folds, creases, and
ripples in the implant. This is especially important in women who have thin
skin and minimal breast tissue who want saline implants. Another advantage of
submuscular placement is a lower incidence of capsular contracture. This
phenomena results in hardening and distortion of the breasts. Patients can also
have significant pain with capsule formation. Capsular contracture can occur
with the implant in either position but the incidence is higher when the
implant is placed on top of the muscle. For these reasons, submusclar placement
gives a more natural look in most cases.

Placement on top of the muscle should be considered in
female body builders who have large muscles which can distort the implant
during contraction. In women with breast sag, implants can be placed on top of
the muscle to avoid a breast lift and scarring.

Every patient should be considered individually. It’s important that you meet with a board certified plastic
surgeon who can help obtain your aesthetic goals. 

SUB-MAMMARY POCKET (over the muscle)The implant is placed over the chest muscle, under only the breast tissue.- good for women with more of their own natural breast tissue so the implant can be hidden better. Also good for tuberous breasts.SUB-PECTORAL POCKET - Dual Plane (under the muscle) - more commonThe top part of the implant is placed under the chest muscle and the bottom third is covered by breast tissue. -creates a natural teardrop shape. The implant is better covered so it's better for women with less of their own breast tissue. Makes mammograms easier to read.You should trust your surgeon's suggestion.

I would agree with most of the previous posts that submuscular is better for most patients.

The major advantages of submuscular placement include 1) softer coverage, 2) less risk of rippling, 3) improved upper breast shape.

The major disadvantages of submuscular implants are 1) A little more painful recovery, 2) implant movement with activity (this can be minimized by appropriate muscle release).

York J. Yates - Utah

There is not really one best answer to this question. The positioning of implants is really left to the patient to select with her surgeon's guidance. My general recommendation is to place the implants under the muscle. The gives a more natural look after surgery, provides a healthy blood supply to surround the implant, and leaves more tissue to cover the implant. In my practice I only recommend that patients who rely on their pectoralis (chest) muscles for a living have their implants over the muscle. I have operated upon body builders, gymnasts, and one trapeze artist who all preferred to leave the muscle untouched. Generally I recommend under the muscle. And in your case I would still recommend going under the muscle.

I hope this info helps!

Thank you for posting photos.  I prefer sub-muscular placement with saline implants when there is little breast tissue to start with, like yours.  The muscle will not die.  It will give better coverage of the implant with less liklihood that you will see rippling.  I personally would not lift your right breast with that size implant, but some surgeons would.

I prefer placing implants under the muscle.  The muscle does not die if the implant is submuscular.

I have found that the submuscular location results in: 1)more tissue covering the implant for a more natural look 2) improved mammograms when compared to the subglandular implants and 3) decreased rate of capsular contracture.