Sagging Breast w/ Skin Tissue and Volume Loss - Submuscular or Subglandular Gel Implants w/ Lift?

confused on if I should get subglandular gel implant with my lift which my ps is recommending or ask for submuscular. I am 42 lost 80# in the last two years now through healthy diet and exercise I am now 5'3and 155# 34C sagging breasts extra skin loss volume. I want to be a full D or DD again and high and tight. I thought under the muscle would be better? Even though it sounds more painful. I'm worried about capsular contraction Gettingtummy tuck too March 14th. Any advice

Doctor Answers 14

Submuscular or subglandular

This would be determined by a physical examination of your concern by an experienced board certified plastic surgeon. It is difficult to say which placement would be better without seeing you in person.

Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Weright loss and subglandular vs submuscular

 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 and especially in those women who have lost weight. The skin has lost volume and elasticity and as such cannot bear the weight of the implant.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

Breast Implant Positioning?

Thank you for the question.

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

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Submusclular Implants

I would recommend a submuscular implant with a full mastopexy/lift.  This technique is the the most widely used and will give you the most coverage of the implant with the least complications.  I think a tummy tuck will also do wonderful for you.  Good luck.

Kindest regards,

Neil J. Zemmel

Neil J. Zemmel, MD, FACS
Richmond Plastic Surgeon
5.0 out of 5 stars 107 reviews

Breast lift with Implant

There are several good reasons to have the implants placed below the muscle which is my preference. 

1. Less likely to see rippling in the upper pole of the breast where most women have lost volume from either weight loss or having been pregnant. 

2. Better visibility of the breast during mammograms.

3. Diminished capsular contracture rates. 

I too would caution with having too large of an implant placed.  The skin of patients who have lost a large amount of weight tend to lose their elasticity and tend to sag sooner and may require more revisions. 

Good luck with your Mommy Makeover !

Brian Joseph MD, FACS

Brian Joseph, MD
Orlando Plastic Surgeon
4.8 out of 5 stars 52 reviews

I prefer the submuscular approach.

I prefer the submuscular approach. 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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Over or Under the Muscle with Breast Augmentation and Lift

I would recommend a submuscular placement for several reasons. 1) If you are having a lift at the same time there is less disruption of the blood supply by going under the muscle. 2) The incidence of capsular contracture is less. 3) You will have a higher chance of rippling down the line with a subglandular implant.

That being said, I would caution you about your expectations as far as "high and tight". Typically women with massive weight loss tend to have thin, inelastic skin. Not only is going very large with the implant going to increase the risks of a complication when doing a combined implant/lift surgery, but also your inelastic skin won't be able to support the size and weight of the implant which would affect the final shape.

Hope that helps and good luck!

Dr. Babak Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 46 reviews

Lift and augmentation later under the muscle would be the best and safest way

The combination  of the mastopexy and augmentation has a high dissatisfaction rate due to the complexity of the combined procedure. The safest thing is to do the lift and  augmentation later. If you decide on the combined procedure,submuscular placement is safest due to the preservation of the blood flow to the nipple.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Submuscular Implants Generally Have Lower Capsular Contracture Rate

Congratulations on your weight loss!  I feel that implants placed submuscularly have a lower rate of capsular contracture.  Since this seems to be an important consideration for you, you might ask your plastic surgeon his/her reasons for suggesting a subglandular placement.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast lift/augmentation and a tummy tuck

You will do well with a tummy tuck.  Your breasts are harder to get a high, full and tight look because of the poor elasticity of your tissues.  I'd advise a submuscular approach with a full lift.  The large size you want maybe can't be safely done that same day as the lift though because the lift tightens you and the big implant stretches you.   

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.