Breast Augmentation Under The Muscle Vs. Over The Muscle

Breast augmentation continues to be one of the most popular aesthetic surgeries in our practice.  At the time of your consultation, you will learn much more about breast augmentation and the results that can be tailored to your goals. Today we want to consider one of the basic issues of breast augmentation; subglandular vs. submuscular breast implants. In simple terms, breast augmentation involves breast implant placement to improve the size, shape, and contour of the breasts. Different types of implants can meet a patient’s needs, and different surgical methods will need to be considered as well.

One of the surgical methods involves the placement of implants relative to the pectoralis major muscle, and the mammary gland, breast tissue. Two options to consider are implant placement in the submuscular vs in the subglandular plane. In the submuscular implant placement, the implant is placed beneath the pectoralis muscle as well as the mammary tissue itself. The implant could be placed completely underneath the muscle, or partially underneath the existing breast tissue, depending upon the patient’s needs and goals of surgery.

The benefits of submuscular placement, in my opinion, include a more long-term, natural result, a more aesthetically pleasing result, and less risk for rippling or visibility of the shell of the implant. In my opinion, implants placed underneath the muscle have a lower risk for capsular contracture, a painful complication where scar tissue develops. Implants underneath the muscle may make mammogram interpretation easier. The disadvantage of placing the implant underneath the muscle is that over time the pectoralis muscle may continue to contract and push the implant slightly laterally. If a patient is extremely active, we do have to worry about implant movement with pectoralis muscle contracture.  Therefore, in some individuals, we consider a subglandular position.

Breast implants that utilize subglandular placement can often be used to achieve fuller or tighter cleavage.  In addition, patients will have less swelling, and less pain and recover faster. The disadvantages of subglandular breast implant placement, in my opinion, have to do with increased inferior migration of the implants over time, gravity pulling everything south, greater palpability of the shell of the implant, greater risk for rippling, especially in a thin individual, greater risk for capsular contracture, and, potentially, a greater risk of leakage.

My general preference is to place implants in the submuscular position. Over the long term, I think that gives a better result. However, there are certain situations where I will recommend a subglandular implant placement. At the time of your consult, this would be reviewed with you, and a more precise surgical plan established.

If you have any questions about breast augmentation, please don’t hesitate to contact the office.