Should I Go Submuscular or Subglandular?

I am 21 and going to be having a breast augmentation in october. I have seen two different surgeons who have both told me different things. im 5'5 and 140lbs im a very small 32D and lack fullness. Im very small up top with a large bottom half and want to be in proportion. The surgeon has recommended 380cc, Should i go submuscular or subglandular?

Doctor Answers 21

Submuscular or subglandular?

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I think that most plastic surgeons prefer to place implants in the submuscular position these days if you are a good candidate.  My reasons for doing so are threefold:  1.  With saline implants, the extra layer of coverage (the chest muscle) over the implant may help minimize the risk of ripples/wrinkles that can possibly be felt or even seen.  2.  The continuous motion of the chest muscle over the implants as you go about your daily routine massages the implants and minimizes the risk of capsular contractures - thick scar tissue capsules that can form around an implant making your breast feel firm or distorting its shape.  3.  There is some suggestion in the literature that it is easier to perform and to interpret mammograms when the implants are placed under the muscle.

The downside to putting an implant under the muscle is that muscle doesn't stretch as easily as breast tissue and skin.  Therefore, it may take longer for the implant to settle and the breast to shape up than it would if the implant were above the chest muscle.  Also, flexing the chest muscle may make the implants move in an unnatural fashion.

Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews

Sub-muscluar or Sub-glangular Breast Implant

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You will find opinions on both sides of this question but most surgeons prefer sub-muscular placement and I include myself in that group for the following reasons:

  • You will have more fullness of the upper breast.
  • The lower portion of the breast will have more support and there will be less sagging over time.
  • Some day you will need a mammagram and it is technically easier to X-ray the breast when there is a layer of muscle separating the breast from the implant.
  • Some research studies have shown a lower risk of hardening of the scar tissue capsule (capsular contracture) around the implant when it is placed under the muscle.

Get more than one opinion before you proceed. Good luck.

Joseph Fata, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 105 reviews

Submuscular or subglandular breast augmentation

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Breast implants may be placed in either a submuscular (under the pectoral muscle) or in a subglandular (above the pectoral muscle) pocket.  An important factor to consider when determining implant location is the amount of breast tissue present above the muscle.  Most augmentation patients tend to be slim females with minimal breast tissue, and in these patients submuscular augmentation provides the best result.  In patients who have a moderate amount of breast tissue over the muscle (approximately B cup breasts or larger), then implants can be placed over the muscle, particularly if silicone gel implants are chosen.

Andrew P. Giacobbe, MD
Buffalo Plastic Surgeon

Breast implant placement and sizing

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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" 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 press 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.

Should I Go Submuscular or Subglandular?

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Seems the majority of previous expert posters chose sub muscular placement. As do I. So I hope that answers your question. 

Under the muscle is better

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There are pros and cons of every decision.  Under the muscle has less chance of hardness (capsular contracture), as well as less chance of obscuring findings on mammogram.  It also has less chance of having problems with breast feeding and less chance of making your breast sag (as there is less "weight on the slinky"effect).  The only thing better is that there is less chance of movement of the implant with flexing.   I would encourage big time going under the muscle, as there is less complications long term.  Check with your Board Certified Plastic Surgeon that is a member of the American Society for Aesthetic Plastic Surgery, as they have more experience in Aesthetic surgery. 

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 35 reviews

Either way can give good results

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I perform breast augmentation both above and below the muscle and have had good results with both.  I have also had some capsular contractures with both.  As a general rule, with saline implants I would prefer to place them under the muscle.  There is less likelihood of capsular formation and wrinkling and rippling that is more palpable above the muscle.  With silicone implants, I think either way will work well.  But for very thin individuals who do not have much breast tissue, I think that under the muscle is better for both saline and silicone implants.  So it depends on the individual.

James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Breast Implant Placement

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Hello Leanneg,

There are surgeons that still routinely place implants over the muscle, however, scientific evidence suggests better performance and lower risk of early and late complications with submuscular placement of implants.  Additionally, I would stay conservative with implant size (380 cc is probably fine), and choose a moderate profile implant.  High profile implants do not perform well over time and are likely to cause unpredictable tissue stretch and tissue thinning, both of which have an effect on breast shape and feel.

Regarding obtaining 'proportion' between your upper body and lower body, I have found that the larger the implants you choose, the heavier you look.  There is no compensatory adjustment that occurs by matching your top with your bottom with large implants. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Subglandular vs Submuscular

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Submuscular has the advantage of having more tissue to cover the implants.

Submuscular usually results shorter recovery

Tony H. Pham, MD
San Jose Plastic Surgeon

Breast implant placement above or below the chest muscle

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There are many advantages of having your breast implants placed subpectoral, instead of subglandular (in front of the muscle). In the subpectoral position there is less risk of capsular contracture, more natural breast contour, higher likelihood of breast feeding and easier interpretation of mammograms. There is less pain associated with subglandular breast implant insertion, but that may be the only advantage. Discuss this in further detail with your plastic surgeon before surgery.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 412 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.