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

My plastic surgeon is considered the best in my city. However, I am confused by his recommendations. He said that he thinks I could get an equally good result with subglandular or submuscular implants, as in his opinion I have sufficient tissue, thick skin, and good skin elasticity. He said that because I have thick pectoral muscles and am very active, he might lean towards subglandular placement, but that he will let me decide which placement I prefer because either way will work for me.

Doctor Answers 10

Under or over?

Hello and thanks for your photosI tend to agree with your surgeon, who sounds very experienced. With your current breast size and shape, its likely that you'll have a lovely result either way. Cohesive silicone implants  have made it possible to place implants above the muscle with very nice results, especially since you are not planning to go very large. In addition, here in Canada we have implant options that are not yet available in the USA, which may decrease the risk of rippling. Conversely, it's very likely that you'll have a lovely result under muscle as well, though you do need to be prepared for the "muscle animation" problem, so make sure you have seen photos of what that can look like with subpectoral implants.Best wishes-

Subglandular compare to submuscular


Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a more narrow cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Breast Augmentation

Thank you for your question and photos. I believe that your surgeon is correct, in that given your present breast shape, you could achieve a very nice result with either procedure.  As with most plastic surgery procedures, the result always begins & ends with what the patient has naturally.  You have a very good shape for breast augmentation. The real question is not what will look good today...but, what will look good for many years to come. I believe that sub-muscular/partial sub-muscular placement is superior to sub-glandular (above-the-muscle)  placement for most patients. Best of luck to you.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 reviews

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

I appreciate your question. The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.   Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection. The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery. Best of luck! Dr. Schwartz Board Certified Plastic Surgeon Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon #RealSelfCORESurgeon

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

Thanks for the question.  I do the vast majority of my surgeries in the partial subpectoral plane but in an active patient like yourself with good thickness of breast tissue either is an option (and a trade-off).  If you're unwilling to reduce upper body exercise and heavy lifting then consider subglandular despite the higher risk of capsular contracture.Another issue that you didn't mention is the appearance of asymmetry and different volumes in your photos.  Perfect symmetry may not be achievable but I would discuss with patients similar to your appearance the intraoperative choice of different size implants as a possibility.  Your pics may be misleading me however you might wish to discuss this with your surgeon before the procedure.Best of luck, Jon A Perlman MD FACS  Certified, American Board of Plastic Surgery  Extreme Makeover Surgeon ABC TV Best of Los Angeles Award 2015, 2016  Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

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

Thank you for the question. The downside of implants placed under the muscle mostly results from a deformity that can occur when the muscle tightens. It deforms the breast slightly while the muscle is flexing. Example videos can be found on YouTube. The downside of a subglandular implant results from not having the extra layer of pectoralis muscle  covering the implant. Visible implant rippling and a palpable edge are more likely. The risk of capsular contracture also increases.  A capsular contracture can be a challenging problem to fix when it occurs.My recommendation for most patients is a dual plane pocket. The top of the implant is covered by pectoralis muscle, while the lower aspect sits in the subglandular plane.Congratulations on your upcoming surgery.

Submuscular or sub glandular with breast augmentation surgery?

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.

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

There are two choices for breast
implant placement: sub-glandular (under the breast tissue and in front of the
chest muscle – the pectoralis muscle) or sub-muscular (under or partially under
the chest muscle). The best location depends on many factors including: tissue
thickness, weight, desired outcome, and individual anatomy. Each position has
advantages 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.
 Subglandular
implant 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 have
breast augmentations today have breast implants placed in a combination or
“dual plane” position. This approach has the same benefits and disadvantages of
a total “submuscular implant”, but with a lesser tendency to ride high on the
chest wall. The disadvantage as compared to a total “submuscular implant” is a
higher tendency for bottoming out. The ideal placement in any
particular patient depends on their particular anatomy and understanding of the
pros 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 advice
from a surgeon on this or any other website who proposes to tell you what to do
based on two dimensional photos without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of each operative procedure may not be in your
best interest. I would suggest that your plastic surgeon be certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for 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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Subglandular breast implants

I am a fan of subglandular placement of breast implants when the patients anatomy favors it.  You have great anatomy and lovely breast aesthetics, you should have an excellent outcome.  I agree with your surgeon that subglandular implants will work well for you for the exact reasons you gave.  The profile of the implant should be determined by your breast measurements and volume desires.  Good Luck.

Submuscular

I highly recommend placing the implant under the muscle. It will reduce future rippling and palpability of the implant. Muscle coverage will help reduce sagging as well 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 40 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.