Choosing Implant Placement: Submuscular vs. Subglandular

When considering breast augmentation, one of the critical decisions to make is the placement of the implants. The two primary options are submuscular (under the chest muscle) and subglandular (over the chest muscle) placement. Each approach has its own set of advantages and disadvantages, and the best choice depends on your individual anatomy, aesthetic goals, and lifestyle. In this post, we’ll explore the differences between submuscular and subglandular implant placement to help you make an informed decision.

Submuscular Implant Placement

Submuscular placement involves positioning the breast implant underneath the pectoralis major muscle, which is the chest muscle located beneath the breast tissue. This method is sometimes referred to as "dual-plane" placement because the implant is partially covered by muscle and partially by breast tissue.

Advantages of Submuscular Placement

1. Natural Look and Feel: Submuscular placement is often preferred for women with little natural breast tissue. The muscle provides an additional layer of coverage over the implant, resulting in a more natural slope and less visibility of the implant edges, especially in the upper breast.
   2. Reduced Risk of Capsular Contracture: Capsular contracture is a complication where the scar tissue around the implant tightens, causing the breast to feel hard. Submuscular placement has been associated with a lower risk of this condition because the muscle may prevent the formation of excess scar tissue.
   3. Less Rippling: Rippling occurs when the edges of the implant become visible through the skin. The additional coverage provided by the muscle in submuscular placement can reduce the likelihood of this happening, particularly in women with thin breast tissue.
   4. Easier Mammogram Imaging: Submuscular implants may interfere less with mammogram imaging, making it easier for radiologists to detect abnormalities in the breast tissue during routine screenings.

Disadvantages of Submuscular Placement

1. Longer Recovery Time: Because the muscle is involved in the surgery, recovery can be more uncomfortable and take longer. Patients may experience more pain and swelling in the initial recovery period compared to subglandular placement.
2. Potential for Implant Movement: Submuscular implants can sometimes shift when the chest muscles are flexed, which can create a temporary distortion in the appearance of the breasts. This is more likely to be noticeable in women who are very athletic or engage in activities that involve frequent chest muscle movement.
3. More Complex Surgery: Placing implants under the muscle is generally a more complex procedure than subglandular placement, which may result in a longer surgery time and potentially higher surgical costs.

Subglandular Implant Placement

Subglandular placement involves positioning the implant directly behind the breast tissue but above the chest muscle. This method can be suitable for women with sufficient natural breast tissue to cover the implant.

Advantages of Subglandular Placement

1. Shorter Recovery Time: Since the muscle is not involved, recovery is typically quicker and less painful than with submuscular placement. Many patients experience less discomfort and can return to normal activities sooner.
2. Easier Surgery: Subglandular placement is a less complex procedure, which can result in shorter surgery times and potentially lower costs.
3. No Muscle Distortion: Women who are very active, particularly those who engage in strength training or other activities that heavily use the chest muscles, may prefer subglandular placement because the implant will not be affected by muscle movement.
4. More Pronounced Cleavage: For women seeking a more dramatic enhancement or a look with more pronounced cleavage, subglandular placement can offer this aesthetic because the implants are positioned closer to the skin surface.

Disadvantages of Subglandular Placement

1. Less Natural Appearance: In women with thinner breast tissue, subglandular implants may appear less natural. The edges of the implant can be more visible, especially at the top of the breast, leading to a more "augmented" look.
2. Higher Risk of Rippling and Capsular Contracture: Without the added coverage of the muscle, subglandular implants are more prone to rippling and capsular contracture. This is particularly true for saline implants or in patients with thin skin.
3. Interference with Mammograms: Subglandular implants may obscure breast tissue during mammogram imaging, making it more challenging to detect abnormalities. However, specialized imaging techniques can mitigate this issue.

Making the Right Choice

The decision between submuscular and subglandular implant placement should be made in consultation with a board-certified plastic surgeon who can assess your anatomy, lifestyle, and aesthetic goals. Here are some factors to consider when making your decision:

• Body Type: Women with thin breast tissue may benefit more from submuscular placement for a more natural look, while those with sufficient breast tissue might find subglandular placement suits their needs.
• Activity Level: If you are highly active and engage in activities that involve chest muscle use, subglandular placement might be more appropriate to avoid implant movement.
• Desired Outcome: Consider whether you prefer a more natural or a more pronounced look, as this will influence the choice of implant placement.

Choosing the right implant placement is crucial to achieving the best results from your breast augmentation. Submuscular and subglandular placements each offer distinct advantages and disadvantages, and the right choice depends on your unique needs and goals. By working closely with a skilled surgeon, you can ensure that your breast augmentation is tailored to your body and delivers the results you desire.