Are subglandular implants a bad idea? Should I get 325 cc high profile placed subglandularly or submuscularly? (photos)

Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.  





Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well. I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.    Best wishes with your upcoming surgery.

There are two choices for breastimplant placement: sub-glandular (under the breast tissue and in front of thechest muscle – the pectoralis muscle) or sub-muscular (under or partially underthe chest muscle). The best location depends on many factors including: tissuethickness, weight, desired outcome, and individual anatomy. Each position hasadvantages and disadvantages:

Subglandular implant benefits:

A shorter recovery time.
Less discomfort initially.
No distortion of the breast when the pectoralis muscle
flexes.
Mild preoperative sagging can be improved, especially
if no breast lifting procedure is performed.
Easier surgical procedure.
Larger implants can be placed.
 Subglandularimplant disadvantages:

The implant may be more visible.
More visible rippling, especially in patients with a
small amount of natural breast tissue.
Generally, saline implants do not produce a good result
in front of the muscle.
Higher incidence of capsular contraction.
“Bottoming out” in some patients.
Some radiologists have more problems reading a
mammogram with an implant in front of the muscle.
 Submuscular implant benefits:

Usually results in a better appearance for naturally
small breasted women
Less tendency for seeing ripples of the implant.
A more natural feel to the breast especially in slender
women who don’t have much of their own breast tissue.
Less interference with mammograms, although most
radiologists take additional views no matter where the implants are
placed.
Lower rate of capsular contraction.
Less of a chance of “bottoming out” where the implant
bulges at the lower aspect of the breast and the nipple and areolas tend
to appear excessively elevated.
Submuscular implant disadvantages:

Recovery usually takes a little longer and is more
uncomfortable initially.
There may be an “animation deformity”, which is a
temporary distortion of the breasts when the pectoralis muscle is flexed.
Body builders and weight lifters generally prefer implants in front of the
muscle.
It is harder to achieve cleavage in women who have
widely spaced breasts.
The implants often ride higher on the chest.
Actually, most patients who havebreast augmentations today have breast implants placed in a combination or“dual plane” position. This approach has the same benefits and disadvantages ofa total “submuscular implant”, but with a lesser tendency to ride high on thechest wall. The disadvantage as compared to a total “submuscular implant” is ahigher tendency for bottoming out.

The ideal placement in anyparticular patient depends on their particular anatomy and understanding of thepros and cons of each approach. A patient with your particular anatomy can achieve a good cosmetic result with either implant position.

Keep in mind, that following the advicefrom a surgeon on this or any other website who proposes to tell you what to dobased on two dimensional photos without examining you, physically feeling thetissue, assessing your desired outcome, taking a full medical history, anddiscussing the pros and cons of each operative procedure may not be in yourbest interest. I would suggest that your plastic surgeon be certified by theAmerican Board of Plastic Surgery and ideally a member of the American Societyfor Aesthetic Plastic Surgery (ASAPS) or the Canadian Society for Aesthetic Plastic Surgery (CSAPS)  that you trust and are comfortable with.You should discuss your concerns with that surgeon in person.  

Robert Singer, MD  FACS

La Jolla, California