Submuscular or Subglandular Implant?

I am going to Brazil in July ( I have family there, speak fluentportuguese, and will be staying for two months). I will be getting a breast aug, bbl, and tummy tuck. The doctor I chose is very accomplished and performed some of his studies here. I have not spoken to him directly (everything has to be done the day of the consultation) and I am curious to see other doctors opinions. I have C cup breasts, that need more firm and are a bit droopy. What type of implant should I get SM or SG? Thanks!

Doctor Answers 19

Breast Implants - Above or Below the Muscle?

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Hi mesdasilva123

Well, that's a lot of surgery planned for that day, but with the language issue already addressed, the fact that you have family there, and the relatively new ability to do excellent consults online, including via Skype, sending of photos and/or followup discussions, it sounds like this represents (at least one part of) the new reality.

So you've narrowed the question down to above or below the muscle.  The short answer is that I recommend below the muscle (actually, subpectoral rather than submuscular, since it's only the pectoral muscle and that means that only the upper portion of the implant is actually covered by muscle - but you (all!) know that by now, right?) whenever possible.  It provides, in my experience, a result that is better aesthetically (it looks and feels "better") as well as from the standpoint point of breast cancer detection.

However, with breasts that are sitting low (droopy, saggy, floppy, etc) the reality is that most of the breast volume will actually be lower than the inferior (lower) edge of the pectoral muscle.  So even less of the implant will actually be covered.

Despite that, I would advise the subpectoral placement of the implant, for the reasons noted above.

I hope that this helps, and good luck,

Dr. E

Breast Augmentation and Medical Tourism

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Your question raises two issues: sub-glandular vs. sub-muscular breast implant placement and medical tourism. The advantages of sub-muscular breast implant placement include more fullness of the upper portion of the breast, more support of the lower breast with less probability of long-term sagging. a separation of your breast tissue and the implant which makes it easier to do a good mammagram, and some earlier research which showed a lower chance of capsular contracture (hardening of the capsule that surrounds the breast). I believe this is the preferred placement for most plastic surgeons.

Medical tourism is a risky venture at best. If everything goes well and you are happy with your results, you still will not have a plastic surgeon to periodically evaluate your breast implants, and breast augmentation is a long-term commitment on the part of both the patient and the plastic surgeon.If you have an immediate complication, you may find yourself in the hands of a health care system that is quite different from what you are used to in the Unted States. Issues such as the safety of the blood supply for transfusions and the standard of intensive care medicine need to be evaluated ahead of time even though it is unlikely you will ever need them. If you have a late complication or even need some minor touch-up procedure, who will take care of you? Finally, you should never put yourself in the hands of a plastic surgeon anywhere who would meet you and operate on you the same day!

Breast Augmentation and Tummy Tuck, San Diego

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If you haven't even spoken to the doctor who will transform your body, and he/she is willing to do the procedure without speaking with you and understanding completely your desired result, motivation, and taken a medical history, and you are asking for answers from other surgeons with whom your surgeon may disagree, I am concerned about the safety and wisdom of the entire plan.

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

Please make sure your surgeon is board certified. 

Location of Breast Implants

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Thank you for the question.

In my opinion,  there are numerous advantages of sub muscular (dual plane) breast augmentation. This  implant positioning will give you the best long-term aesthetic results and reduce the chances of complications such as significant rippling/comparability/ encapsulation and interference with mammography.

Best wishes.

Subglandular or subpectoral surgery in Brazil

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My goodness:  this really is a question that you and your Brazilian surgeon should have discussed already.  It is concerning that your surgeon did not cover this material with you.

Personally, I'm a fan of the partial retro-pectoral or dual plane approach for most women, but some of this decision making depends on your build and your appearance goals.  Scientific studies show:  better mammograms, less capsular contracture, and less rippling with implant covered by the pec. muscle. 

Best wishes,

Need to discuss surgery specifics with your plastic surgeon

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Procedures performed in in other countries require a bit or risk taking.   Standard may not be the same as in the US.   If you have chosen a surgeon in Brazil it is possible that you are familiar with his work and trust his judgment.  Without an examination no one would be in the position to tell you if your implant should be placed either above or below the pectoralis muscle.  Th's is an individual decision based upon your anatomy.   An open discussion with your plastic surgeon is in order.  

Medical tourism

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I do not think it is a good idea to undergo surgery without having had spoken to the surgeon before surgery. A day before surgery is a bit late in the game. It does not allow you to "digest" the information at the consult in most cases.

Medical tourism not wise for you

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The least of your problems is where to place the implants. You are discussing major surgery with multiple procedures, in a foreign country, and seeing the doctor the same day of the surgery.

Big mistake!!

Surgery should not be taken lightly and your plan is fraught with too many variables and issues, any one which could spell disaster for you. What if you had a major complication - how would that be addressed? Hospital costs - will you be covered by your insurance in the event of a disaster (for example, pulmonary embolus)? Pay out of pocket?

If you are dissatisfied or have problems, how are they going to be addressed? Medically? Legally?

What are the facilities like. What type of personnel are used including for your anesthesia?

I could go on ... but hopefully you get the gist.


Please send your pictures

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The least for evaluation is pictures and the best is personal examination. I can not tell if your even a good candidate for the augmentation.  i would suggest that you send pictures to your surgeon in Brazil for pre surgery evaluation.

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.