Submuscular vs Subglandular Breast Implant Placement

What Is the Best Breast Implant Placement?

When you’re considering breast augmentation, one of the most significant decisions you’ll face is choosing between submuscular and subglandular implant placements. This choice isn’t merely a matter of aesthetic preference; it’s a complex decision that intertwines with your lifestyle, health considerations, and personal desires. The decision to opt for either submuscular or subglandular placement can be influenced by various factors like your daily activities, your body’s natural anatomy, and your long-term health goals.

For instance, if you’re an athlete or regularly engage in vigorous physical activities, the placement of the implant can have a substantial impact on your comfort and performance. Similarly, your body’s natural anatomy, including the thickness of your breast tissue and the shape of your chest wall, plays an important role in determining which placement will offer the most natural-looking results. Health concerns, such as the ease of mammography screenings and the risk of capsular contracture, also weigh heavily in this decision. Beyond these factors, personal preferences in terms of look and feel are equally important. Some may prefer the more natural appearance often associated with submuscular placement, while others might opt for the more pronounced look that subglandular placement can provide.

In this blog, plastic surgeon Dr Jake Lim offers a complex exploration of both submuscular and subglandular breast implant placements, covering their benefits, drawbacks, and the various factors that might influence your decision.

Download Dr Lim’s 2024 Breast Surgery Guide

Submuscular Placement: Under the Muscle

When you’re considering submuscular placement for breast implants, it’s essential to understand what this entails. In this procedure, the implant is placed under the pectoral muscle, located just beneath your breast tissue. This positioning is often more intricate than other methods because it involves carefully placing the implant under the muscle, ensuring that it’s properly secured and positioned to achieve a natural-looking outcome.

The process starts with a consultation where Dr Lim will evaluate your anatomy and discuss your goals
During the surgery, a small incision is made, usually under the breast or around the nipple
Dr Lim then creates a pocket underneath the pectoral muscle and carefully inserts the implant
Once the implant is in place, the skin is closed with sutures

Advantages of Submuscular Placement

One of the key advantages of submuscular placement is the natural look and feel it offers. This method provides a more natural contour to your breasts, with the muscle creating a smooth gradient at the top of the breast. This avoids the unnatural appearance often referred to as the ‘bolted on’ look. It’s especially ideal for women who have less natural breast tissue, as the muscle effectively covers part of the implant, making it less noticeable.

Another significant benefit of submuscular placement is the reduced risk of capsular contracture. Capsular contracture is a condition where scar tissue forms around the implant, causing it to harden. By placing the implant under the muscle, the likelihood of this condition occurring is markedly reduced. This is an important health advantage, considering that capsular contracture can be painful and might require additional surgery to correct.

Furthermore, submuscular placement enhances the effectiveness of mammograms. With the implant positioned under the muscle, there’s a clearer view of the breast tissue during screenings. This aspect is particularly crucial for regular breast cancer screenings, as it ensures any changes in the breast tissue are detected early. The improved mammogram results contribute to better overall breast health monitoring for women with submuscular implants.

Disadvantages of Submuscular Placement

One of the primary disadvantages of submuscular breast implant placement is the longer recovery time it entails. This method’s recovery period can be more extensive compared to other placement techniques. Since the muscle underneath which the implant is placed needs time to heal, this often translates into a longer duration of rest and limited physical activity. Initially, you might experience more discomfort, and full recovery can take several weeks. It’s important to plan for this extended downtime and follow Dr Lim’s advice for a smooth recovery process.

Another consideration with submuscular placement is the possible impact on muscle function. Post-surgery, you may notice changes in how your chest muscles perform. This can include a sensation of tightness or difficulty in performing certain movements. While these effects generally improve over time, they can be particularly noticeable in the early stages, especially for individuals who are physically active. Adjusting to these changes is an essential part of the recovery process.

Additionally, submuscular placement often leads to more significant pain and discomfort immediately following the surgery. This increased discomfort is attributed to the stretching and manipulation of the muscle during the implant procedure. Effective pain management is crucial in the initial recovery phase. Your plastic surgeon will play a key role in guiding you through managing this pain effectively, ensuring your comfort and aiding in a smoother healing process. It’s vital to closely adhere to Dr Lim’s advice and any prescribed pain management plans.

Subglandular Placement: Above the Muscle

In subglandular placement, the implant is placed above the pectoral muscle but beneath the breast tissue. This option is often chosen by women who have a moderate amount of natural breast tissue or who seek a more pronounced augmentation effect.

Advantages of Subglandular Breast Implant Placement

One of the major advantages of subglandular breast implant placement, where the implant is placed above the chest muscle and beneath the breast tissue, is the shorter recovery time. Unlike submuscular placement, the chest muscles are not disturbed during the procedure, leading to a generally quicker and less painful recovery process. This can be a significant consideration for many, especially those who cannot afford a lengthy downtime or have a lower threshold for pain.

Another advantage is the reduced pain during recovery. Patients who opt for subglandular placement often report experiencing less discomfort during the recovery phase compared to those who undergo submuscular placement. This reduced pain level can make the post-surgery experience more manageable and less stressful, allowing for a smoother and potentially quicker return to daily activities.

Additionally, subglandular placement avoids the distortion of implants during muscle contraction. This is particularly beneficial for active individuals or those who engage in activities that involve frequent chest muscle contraction. Since the implant is not placed under the muscle, the shape of the breast remains consistent and unaffected by muscle movements, maintaining a stable and uniform appearance regardless of physical activity.

Disadvantages of Subglandular Breast Implant Placement

However, subglandular placement is not without its disadvantages. One notable concern is the higher risk of capsular contracture, a condition where the scar tissue around the implant tightens and hardens. This can cause discomfort and may affect the appearance of the breast, potentially necessitating further surgical intervention. The increased risk of this complication is a significant factor to consider when choosing this placement method.

Another disadvantage is the potential for more obvious implant edges. In subglandular placement, the implants are closer to the surface of the skin, making the edges potentially more visible, particularly in individuals with thinner skin or less natural breast tissue. This can affect the overall aesthetic outcome, with the implants appearing less natural or ‘blended’ with the body’s contours.

Finally, challenges in mammography are another drawback of subglandular placement. Since the implant is placed directly behind the breast tissue, it can obscure more of the breast tissue during mammogram screenings. This can make it more difficult to interpret the mammogram results accurately, potentially impacting breast health monitoring and cancer detection. Women considering subglandular placement should discuss these implications with Dr Jake Lim to ensure they make a fully informed decision.

Factors Influencing Your Breast Implant Placement Choice

Body Type and Breast Tissue Thickness: Your natural body shape and the amount of existing breast tissue significantly influence the choice of implant placement. Submuscular placement might be better for those with less natural breast tissue, whereas subglandular could be suitable for those with more
Existing Health Conditions and Surgical History: Consideration of any existing health conditions, such as autoimmune diseases or bleeding disorders, is important. Previous surgeries in the chest area may also impact the choice of placement
Future Mammography Considerations: If regular breast screenings are a priority, particularly for those with a family history of breast cancer, submuscular placement might be more appropriate due to its lesser interference with mammogram imaging
Impact on Physical Activities and Sports: For active individuals, especially those involved in bodybuilding or strength training, submuscular placement might cause some hindrance or change in muscle function. Subglandular placement may be more suitable for such lifestyles but implants may be more noticeable if less soft tissue cover
Daily Life Adjustments Post-Surgery: Consider how each option may impact your daily activities and the adjustments you may need to make during the recovery period and beyond
Long-Term Maintenance and Care: Both options require different approaches to long-term care and maintenance, including the potential need for revision surgeries
Desired Look and Feel: Your aesthetic goals play a crucial role. Whether you’re seeking a more natural appearance or a more noticeable augmentation will guide your decision between submuscular and subglandular placements
Balancing Natural Appearance with Personal Desires: Understanding how each placement affects the final appearance and feeling of the breasts is key to making a decision that aligns with your personal aesthetic goals
Managing Expectations vs Reality: It’s important to have realistic expectations about the outcomes of each placement option, and to understand that individual results can vary

FAQs about Breast Implant Placement

Can breast implant placement affect future breastfeeding?

Many prospective patients wonder if the placement of breast implants affects the ability to breastfeed in the future. The impact on breastfeeding can depend on the specifics of the surgery, including the incision location and any nerve damage. Generally, submuscular placement is less likely to interfere with breastfeeding ducts and nerves.

How does age impact the decision between submuscular and subglandular placement?

Age can be a factor in deciding the optimal placement of breast implants. As the skin and tissues change with age, the amount of natural breast tissue available can vary. Older patients might opt for submuscular placement to achieve a more natural look, especially if they have experienced tissue thinning over time.

Are there specific risks associated with each type of placement in terms of implant longevity?

The longevity of breast implants can be influenced by their placement. Subglandular implants may have a higher risk of rippling and may be more prone to gravity-induced changes over time. Submuscular implants, while generally more stable, can be affected by muscle movement and may require revision if muscle distortion becomes pronounced.

Does the choice of implant type (silicone vs saline) affect the decision on placement?

The type of implant – silicone or saline – can influence the recommended placement. Silicone implants, which are denser, might be better suited for submuscular placement in patients with less natural breast tissue, as this can offer a more natural appearance. Saline implants might be more suitable for subglandular placement in patients who already have a significant amount of breast tissue.

What role does skin elasticity play in choosing the implant placement?

Skin elasticity is an important factor in determining implant placement. Patients with good skin elasticity may have more flexibility in their choice of placement, as their skin can better accommodate the implant. In contrast, those with less elasticity, often due to age or significant weight fluctuations, might be advised to opt for submuscular placement to ensure a more natural appearance and support for the implant.

Medical References about Breast Implant Placement

Breast Augmentation – American Society of Plastic Surgeons
Where Will Your Breast Implants Be Placed? – American Society of Plastic Surgeons
Breast Implants – Cleveland Clinic
Dual Plane versus Subpectoral Breast Augmentation – NCBI
Placement of Breast Implants – Mayo Clinic

Submuscular vs Subglandular Breast Implant Placement (Augmentation)