Submuscular or subfascial for an active person? I'm 5'4, 130 lbs, and 32 AA.

Hi. Similar to some of the other comments I basically consider there to be 2 choices. One is under the muscle (or dual plane, which means mainly under the muscle but partly under the breast gland itself). The other choice is subglandular which is under the breast gland itself. To me a subfascial placement is more of a marketing gimmick, no offense to those who push that. But the fascia on the chest muscle is typically thinner than a tissue. So the idea of there being truly a difference between trying to put it under this layer (and considering that layer to truly either be intact or not) or above that layer, I think it is not likely to be a situation where there really is any difference between above or below the fascia. In your situation with a very active lifestyle etc., it really can be a bit of a rock and a hard place decision. Above the muscle can be helpful to avoid the pectoral animation deformity may see when doing weight lifting etc. But at your stated height weight in breast size you likely have very little tissue there to camouflage an implant that is above the muscle so it may be something where you are not happy with the appearance because of that.
Good luck and take care,
Dr. Howell

There are essentially 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 and desired outcome..

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do 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 you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California