Subglandular or submuscular ? (photos)

Question

I was adviced that since I don't have a shape to my breasts I would benefit from sub glandular implant rather than submuscular. What are the pros and cons? Should I do it?

Shlomo Widder, MD · Answer

Dear Dollface,   Thanks for submitting your pictures. From your pictures, you appear to be small A cup with wide cleavage and right breast is larger than left breast. In 28 years of plastic surgery practice with thousands of breasts augmentation surgeries, I have use exclusively the sub muscular technique. Through the years, I have done breasts augmentation on many mothers and daughters which is quite indicative for the successful technique. The advantages are as follows : 1. Less loss of sensation since the nerves are crossing over the muscle, just beneath the gland and so the pocket dissection is less likely to damage the nerves. 2. Better coverage of the implants with less palpability and ripples. 3. Statistically, less capsule contracture (hardening of the breasts ) . Full C cup will be a very nice size for you. For the exact implants size you will have to have your surgeon take the chest circumference measurement. If you are 34 small A , the correct size will be roughly , 450 cc. Always, consult with experienced board  certified plastic surgeons who operate in accredited surgery center for your safety. Check the before and after pictures in the photo gallery to make sure that they are numerous, consistent and attractive. Pay special attention to the cleavage area, the perkiness, the symmetry and natural look.                        Best of luck,                                              Dr Widder

Larry S. Nichter, MD, MS, FACS · Answer

Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity

Rodger Shortt, FRCSC · Answer

HiI think that a subglandular pocket could look great.  It can give nice shape.  It doesn't cause the breast to move or animate when you contract the muscle.  It has less pain after surgery and faster recovery.  And probably gives you a nicer result for longer as the implant and the breast start to come down together over time.  If you don't want to go too large (over 200-225 cc) then based on photos I would suggest a sub glandular pocket.  If you want to go much larger or you have thin tissue, to be determined at your breast augmentation consultation, then sub muscular.  This is a good example of why you need to customize the surgical plan to best match your goals and your current situation.Good luck,Dr Rodger ShorttOakville Plastic SurgeonDirector of Cosmetic Surgery TrainingMcMaster University

William Andrade, MD · Answer

Thanks for you inquiry.  The photos don't show your entire breasts but from what is visible, the breasts seem to be small with no sagging.  For patients with this chest type I usually recommend implants under the muscle, so there is a thicker layer of tissue covering the implants.  This should decrease the chance of seeing or feeling the edge of the implant, or rippling.  I find this works well in my practice.

Jairo Ulerio, MD · Answer

Thank you for submit your pictures.  In your case specifically  having a size A doesn't  have the enough  cover for the implants.  my recommendation will be  in a dual plane  or sub muscular plane  to secure  a correct  coverage  of implant   and  a best  esthetic result.

Ira H. Rex III, MD · Answer

Based on your photographs and the fact that it seems like you have very little amount of your native breast tissue

Christian Subbio, MD · Answer

You may have been told that sub-glandular is a good option for you because with less tissue (muscle) covering the implant, the implant's round or teardrop shape might show through better, (giving form to an otherwise shapeless breast). However, the downside with subglandular & less tissue covering (no muscle to cover the implant) is threefold:1--there is a reported higher rate of capsular contracture-- the thick scar that forms around some implants, making them feel firm and potentially distorting them. 2--Since your breasts are small and without much gland and fat to cover the implant, you need all the coverage you can get. Without the muscle overlying the implant, the edges might show through, making the contours less soft, and potentially exposing some rippling as time goes on. 3-- with less covering, the implant will feel less soft. Having that extra layer of muscle over top gives another layer of soft natural tissue to mask what might otherwise feel firm and unnatural. So, in the end, it's about covering the implant as best possible to make it look soft, feel soft, and lower the rate of capsular contracture and surgical revisions. For you, as best I can tell without examining you, I'd recommend a shaped "gummy bear" implant placed under the muscle. That will give you the shape you're looking for but the coverage you need. Hope this helps. Good luck!

Gregory T. Lynam, MD · Answer

I would not offer you a sub glandular augmentation! I think you would have a poor result. please seek out a board certified plastic surgeon.

Robert M. Tornambe, MD · Answer

Physical exam is important but from your photos it appears that you would benefit most from a  submuscular placement using silicone implants. You have very small Breasts and you are petite. The extra coverage from the muscle will give you a more natural result. Good luck!

Vincent N. Zubowicz, MD · Answer

Having done both extensively over the years I prefer sub glandular placement for silicone gel implants in most the time sub muscular for saline. There are specific issues but in your particular case the overall breast shape is fine and if you choose silicone gel I would recommend sub glandular.

Subglandular or submuscular ? (photos)

Answers (17)

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