I am Thin but I Want Subglandular Implants. Is This a Bad Idea?

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
 

There are really great reasons to get breast implants over the muscle instead of under the muscle, but I have not noticed a big difference in the amount of pain the patient encounters. I would suggest Subglandular placement if you were a fitness professional or had another medical requirement. If you a fear of the actual incision you should talk that fear over with your plastic surgeon at your consultation. I usually choose to go under the muscle so it doesn’t interfere with the milk ducts and to provides more camouflage for the implants themselves. Talk to your surgeon about your concerns and questions.

Conventional wisdom states that if you want the most camoflouged edges to your implants and want to decrease the risk of capsular contrature then the implants should be placed under the muscle.  This gives the maximal amount of tissue covering the implants.  However, it is not a bad idea to place the implants in a subglandular position as long as you are willing to accept the trade offs.  Silicone implants would be a better choice to minimize the risk of visible rippling although in very thin patients there is simply no coverage to hide any contour irregularities.  Have a through discussion with your plastic surgeon so you understand both benefits and risks before choosing.  Good luck!

Although the standard thinking about breast implant placement is limited to over or under, there are really 4 options. The traditional under muscle placement, called "dual plane," does involve cutting the muscle off of its attachment to the ribs, which can lead to a number of problems. Another option is a split-muscle technique, which preserves all of the muscle's natural attachments and function while covering the upper part of the implant where it is most beneficial. Over-muscle placement can be done with a subfascial technique, which doesn't add much in the way of coverage but can add support and is useful in some situations. We use the subfascial and split muscle options a lot in athletic patients, who are often thin and muscular.

If you are very thin, you are probably better off having the implants placed in a biplanar pocket( partial submuscular).  It will help minimize the risk of rippling in the upper portion of the breast.