Im 20yrs weight 145 ht 5'0 36b .. and I have a lot of breast tissue mild droop. i had 1 baby and breastfed. what would look better and natural submuscular, partial, duel or subglandular? thks for ur help
What's Better - Submuscular or Subglandular?
Doctor Answers 28
Breast Enhancement Surgery
Submuscular breast implants
The next very compelling reason to select sub-pectoral placement is a cosmetic one. Implants placed on top of the pec major tend to stand out in the upper pole of the breast, creating a rounded, convex and distinctly unnatural-appearing breast profile. With implants in a sub-pectoral position, the upper pole of the implant is flattened somewhat by the muscle, helping to create a smooth transition from the area in the upper chest where the breast begins, and a gradual slope towards the nipple that is not excessively rounded or convex. In some patients with a fuller breast volume preoperatively one may get an acceptable appearance with pre-pectoral placement - initially. The problem is that as breasts age, the fatty tissue atrophies and breast tissue thins out, and the area where this is most obvious is in the upper pole and cleavage area. So a pre-pectoral implant that was initially well-concealed may, after a few years, become painfully obvious (including visible implant folds and ripples) in the upper pole.
'Under the muscle' and 'sub-pectoral' are actually somewhat misleading terms, as in most cases the implant is only partially subpectoral. The anatomy of the pectoralis major muscle is such that it is actually just the upper/medial half of the implant that is covered by the muscle, while the lower/lateral half of the implant is submammary. The pectoralis major thus provides an additional layer of tissue to conceal the implant in the most cosmetically significant area of the breast: the cleavage area. This is why saline implants are often easy to feel laterally, as they are covered by breast tissue only in lateral aspect of the breast, and in slender patients who have small breasts preoperatively the implant is often immediately under the skin in this area.
The natural looking breast implant
I offer patient's a simple analogy to illustrate what we mean:
Q: If you take a baseball and you cover it with a silksheet, what will it look like?
A: Like a baseball, you will even see the stitching.
Q: Now if you take that same baseball and cover it with a comforter what will you see?
A: It depends on how thick the comforter is but generally you will see a softly shaped lump.
So now the question is what do you have on your chest, silk sheets or comforters?
The way we determine this is by looking at your chest, if I can see your ribs (under the muscle) then you anatomy will have a hard time disguising the implant whether it is placed under or over the muscle and you are more likely better off with a silicone implant. Another way of measuring this is to pinch your upper chest skin (similar to pinch and inch of your waist on the Special K commercial). If you have less than an 2 cm (under 4/5 of an inch) than you have "silk sheets"
If you have a thicker skin/fat/breast layer that pinches over an inch than you have the option of going under or over.
Now the exception to the rule:
Q: What happens if you change the baseball to a volleyball?
A: All bets are off, whether you put it under or over the muscle it will not look natural.
The last issue is the implant shape. There are some anatomic shaped implants but I have generally found them to produce no significant difference in outcome with the exception of breast cancer reconstruction. However, this is my personal opinion.
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Subglandular better to lift droopy breasts
If you have some drooping of the breast tissue, such that the nipple is lower than the level of the crease under the breast (where an underwire would go), subglandular implant placement is probably a better choice. It sounds like you have enough breast tissue to cover the implant well, such that visible implant edges and ripples shouldn't be a problem.
Subglandular VS. Submuscular
Sub muscular vs Sub Glandular placement
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
Each patient is different, most surgeons prefer submuscular.
In the context of these discussions, we feel that every patient needs to be considered individually.Each patient has unique anatomic findings that affect 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 implants in either position but the incidence is higher when the implant is placed on top of the muscle.For these reasons, submuscular placement gives a more natural look, in most cases.
Placement of the implant on top of the muscle should be considered in female body builders who have large muscles which can distort the implants during contraction.In women with severe breast sag, implants can be placed on top of the muscle to avoid a breast lift and scarring.
When patients have mild breast sag, a duel plane breast augmentation offers the advantages of submuscular placement while also addressing breast sag.In your case, this may represent your best option.It’s important that every patient be considered individually.It’s therefore, important to consult a board certified plastic surgeon who has experience in this area.
Submusclular or subglandular.
The sizes are done with the width of the chest wall. Your skin quality is the main determinant of location and so the best person to answer this question is your plastic surgeon. In my practice a majority of women get submuscular implants.
Position Of Breast Implants?
Generally implants should be placed in the partially submuscular position (dual plane) for the best results and avoidance of complications.
Some general advice regarding breast implant sizing may be helpful.
Much of the final “look” achieved after breast augmentation surgery depends on several factors: 1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal. 2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant. 3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue.
4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
No approach is better
There are essentially 3 approaches to breast augmentation, subglandular (subfascial), submuscular, and dual plane (partially submuscular). The approach chosen depends on many factors, including the appearance of your breasts, tissue thickness, breast position and of course the type of appearance of your breasts that you are looking for. All the approaches mentioned have advantages and disadvantages. The main disadvantages of subglandular are a higher capsular contracture rate and visibility of implants if your tissues are thin. This can also be affected depending on your choice of saline or gel implants.
Ideally choose a surgeon that can offer you all approaches, under, over and dual plane, as well as saline, gel and even fat grafting for breast augmentation. You should also be able to discuss your choice of incision. The discussion should include your actual body and breast type, tissue thickness, how you expect to look, advantages and disadvantages of each approach.
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.