What's Better - Submuscular or Subglandular?

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

Doctor Answers 29

Submuscular breast implants

This may be a somewhat controversial statement, but in my opinion there currently is really only one acceptable position for breast implants in an elective cosmetic surgery patient: behind the pectoralis major muscle (sub-pectoral augmentation). There are a number of very compelling reasons to place implants behind the pec major, and the most compelling one of all is the fact that radiologists report that the mammographic imaging of breasts for the purpose of breast cancer screening tends to be more easily accomplished when breast implants are sub-pectoral (compared to pre-pectoral, also referred to as the 'sub-mammary' position). An American woman's current lifetime risk of breast cancer is approximately 1 in 8 to 1 in 9, so the issue of breast cancer screening must be taken very seriously. Mammography is by no means a perfect screening study, but it is the standard of care at this point in time. The most sensitive and specific test for breast cancer is a contrast-enhanced MRI scan, and breast implants do not impair breast tissue visualization by MRI.
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.


Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Breast Enhancement Surgery

Way too much to talk about it hear, if you have good soft tissue or upper breast skin thickness and you use your muscles a lot or work out than I think subglandular is a good alternative for smaller implants

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 72 reviews

Submuscular or subglandular placement of implants

As a rule, I prefer subglandular placement of implants if there is enough breast tissue to cover the implant.  Perhaps this has something to do with the fact that I mainly use silicone implants (I am based in the UK).  The operation is less traumatic, there is less bleeding and less postoperative pain compared with submuscular.  However, if there is not enough soft tissue to cover the implant, I will use a submuscular pocket.

Jonathan J. Staiano, FRCS (Plast)
Birmingham Plastic Surgeon
5.0 out of 5 stars 19 reviews

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. 

Amy M. Sprole, MD
Wichita Plastic Surgeon
5.0 out of 5 stars 6 reviews

With early ptosis and enough breast tissue, I feel that sub glandular gel implants give far better results with a breast augment

I feel that when ever the woman has adequate breast tissue to cover the gel implants, sub mammary or sub glandular placement of the breast implants gives  much more natural looking and feeling breasts with breast augmentation. This is especially true if there is some early ptosis, drooping of the breast. 


When the woman has very little breast tissue, putting it under the breast often will lead to ripples and folds that can be felt or seen. In these cases it is necessary to put the implants under the muscle but I would definitely prefer gel implants over the saline again for a more natural look and feel. 

If  you do develop ripples or folds they can often be covered by fat grafting to the breast. 

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 15 reviews

Dual Plane Placement or Submuscular

Thank you for your question. I would need to examine you in person to make a full recommendation, but the dual plane breast augmentation might suit you as it would provide you a bit of a lift. It is not a replacement for a mastopexy, breast lift, though. Otherwise, I generally favor the submuscular placement.

Good luck, and for more information about other choices to be made before undergoing breast augmentation, take a look at the Guide to Breast Augmentation on my website from the web reference below. I discuss common patient questions I receive, silicone versus saline implants, round versus anatomically shaped implants, smooth versus texturized implants, implant manufacturer, implant insertion incision location, implant location inside the breast, and more. 

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 22 reviews

Subglandular VS. Submuscular

The saline implants are filled with salt water and are placed either in front or behind the pectoralis major muscle and breast tissue. #Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle. This tends to more common in Europe and South America. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option, #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding. In any case, your plastic surgeon will determine which placement is best for you.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Each patient is different, most surgeons prefer submuscular.

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 a convincing argument 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 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.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

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.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 34 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.