Subglandular for my Breast Anatomy? (photo)

Hi, I am scheduled March 8th for a BA with over the muscle saline implants, possibly 450 cc's. I currently wear a 38B, 36C and have a 34 inch ribcage. I DO NOT want a breast lift. The PS I have chosen suggests over the muscle, and says due to my breast anatomy under the muscle may make the implants/breasts look distorted. I am looking for some advise (not the response with "go with what you PS says, lol"). With pics and info I have provided, what would you recommend? I don't want ball in a sack.

Doctor Answers 23

Breast Implant above or below the muscle?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


Because you have a fair amount of droop to your breasts your options are limited. Based on the pictures you either need a lift with a submuscular implant or a sub-glandular implant to expand the breast envelope to its maximum (this will not completely correct the droop though).I would not recommend a 450 cc saline implant above the muscle however, as it will show obvious rippling. I recomend a smaller (400 cc silicone implant) in the subglandular plane with the knowledge that you may need or desire a lift in the future. Good luck with your decision.


Daniel Medalie, MD

Subglandular for my Breast Anatomy?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Some surgeons recommend subglandular implants for patients with ptosis as they feel that they will better fill out a loose skin envelope and help them avoid a lift. Unfortunately this rarely works, and even if it does for a time the patient's tissues stretch more under the weight of the implant than they would if the implant was subpectoral and a worse problem develops with irreversible thinning of the tissues and more sagging.  A dual plane approach would offer better coverage, better support, and still allow the implant to fill out your loose tissues. Saline implants over the muscle are not in my experience a very good option...they require even more coverage than gel implants (as in subpectoral positioning) and they have an even worse long term stretching effect.  It is difficult to tell how much overhang you have without examining you, but if you do not mind your nipples remaining VERY low on your breasts, there is a possibility (not a probability, but a possibility) that you could get an acceptable result from augmentation if a dual plane approach was used.  If this does not give you a satisfactory contour, you will need a breast lift in order to achieve one.  If you are not willing to undergo a breast lift and accept the scars of a breast lift, do not take the chance and have implants, as you are taking a chance that an augmentation alone will not give you a pleasing result.

Subglandular for my Breast Anatomy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you will not accept a breast lift, I would advise against breast implants. It is highly likely that your own breast tissue will wind up hanging off the implants, a very unsatisfying appearance. Then your choices will be three:

  • live with an unsatisfying outcomej
  • have a breast lift
  • have the implants removed, and perhaps be worse off than when you started and only a lift would solve that. 

In terms of implant position, saline implants that large with the amount of breast tissue cover will also be unsatisfactory with high likelihood of ripples that will be palpable and possibly visible. 

If you don't want a ball in a sack, and you don't want a lift, don't get implants. All the best. 


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Implants above or below the muscle

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Unlike many of my colleagues, I think you will do fine with saline implants over the muscle BUT you need to understand that this will make your breasts larger and not change the position of your nipples. They will still be saggy. But this is quite normal for women with large breasts. Saline implants do tend to show wrinkles more than gel, but you have enough of your own tissue so that I don't think that will be a major problem for you. So as long as you understand that you will still be saggy (and larger implants/breasts do tend to sag more) and both you and your surgeon are happy with this, you should be fine. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

"Ball in a Sack", "Rock in a Sock"

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear New Me,

You cannot say "I don't want a lift and I don't want a ball in a sack" in the same sentence.  For you, they are almost mutually exclusive.  The only characteristic that may save you, is the wide base of your breasts.  But I don't know if I'd bank on that.  Good luck!

Sagging needs to be addressed before any Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have saggy breasts.  You will need lift to look good after breast enlargement.  Augmentation without lift will make your breasts even saggier.  Submuscular implants without lift will give you instantaneous double bubble deformity.

Subglandular silicone gel implants give most natural breast results.  Nature designed woman's breast in front of the muscle and that is way it should remain after any plastic surgery (some excetions to this rule do exist).  

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Subglandular for my Breast Anatomy? (photo)

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I know you don't want a lift.....but...eventually you are going to need one. Right now your nipple and areola are the lowest parts of your breast and I think the only option for you at this point is above the muscle, or very very high dual plane, knowing that you will be droopy and most likely will need a lift in the near future...Implants will make you droop faster as well...

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Subglandular Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello NewMePls,

Do not go with what your PS says! Subglandular breast augmentation with saline implants has no home.  It is arcane, and will give you a poor result that will get worse with time - ball in a sack.

You have breast ptosis (sagging) and this would best be addressed at the time of breast augmentation.  No technique of breast augmentation alone will make your breasts look as nice as they would with a breast lift too.

Please do yourself a real favor and meet with a few breast specialists in your city. These surgeons perform all types of cosmetic breast surgery, including breast lifts, reductions, and revisions.

Best of luck!

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

Wailt Before You Proceed

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Ok.  No company line statement.  You have ptosis (droop).  Placing subglandular implants into droopy breasts will give you larger droopy breasts.  You will need a lift in addition to implants (subglandular or submuscular).  Silicone implants if you are going to go subglandular are recommended. 

A dual plan augmentation, silicone implants and a lift would give you the result that you most likely desire.


Dr. ES

Implant pocket

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I prefer placing most implants under the muscle for more soft tisse coverage.  You may need a lift as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.