Subglandular vs. Submuscular

By Dr. Pousti 9/12/2012

Revisionary breast surgery may be necessary when a patient does not achieve the desired result following their primary breast procedure. Candidates for breast augmentation revision include women who experience asymmetry, rippling, palpation, or capsular contracture of their implants. According to the American Society of Plastic Surgeons, there were 86,424 patients who experienced breast reconstruction/ breast revision surgery in 2009.

There are a number of determining factors that need to be taken into consideration when choosing the appropriate breast implants and placement of the implants to obtain the best results for the patient. Depending on the patient's current breast size and their overall goals, the implants may be placed under the mammary gland (subglandular) or under the pectoral muscle (submuscular). Each type has its own individual benefits and drawbacks.

Subglandular implants are placed directly behind the natural breast tissue and in front of the pectoral muscle. Placing implants over the muscle allows larger implants to be used and more cleavage can be easily created with less recovery time and less discomfort because there is no disturbance of the musculature. This is not usually the choice of Dr. Pousti for a primary augmentation.

Despite these positives, there is more risk for rippling and palpation of the implants. Mammograms are more difficult to perform and the overall look will be more rounded and unnatural. Women who have very little breast tissue to begin with are not good candidates for this type of placement. Also, capsular contracture is more likely to occur with implants placed over-the-muscle. This condition involves scar tissue formed around the implant causing firmness. It can become painful over time and may cause the breasts to appear deformed. Lastly, athletes and active women may prefer subglandular implants because it won't affect their muscles. Implants placed under the muscles can look distorted and unnatural when the chest is flexed, which can be very concerning for women who weight train or professional body builders.

Subglandular vs. Submuscular
This 40-year-old patient from Las Vegas, Nevada was unhappy with the appearance of her breasts. Initially, her implants were placed over the muscle by a surgeon in Las Vegas.
Subglandular vs. Submuscular Subglandular vs. Submuscular
In order to achieve the patient's goals, Dr. Pousti discussed a 2 staged procedure with the patient. The first stage is when the patient's implants are removed and a breast lift (mastopexy) was performed. After a couple months of allowing the incisions to heal, the patient returns for the breast augmentation portion of the surgery. The implants can now be placed submuscularly for the "look" that she is wishing to achieve.. She is very happy with her results, thus far.

Submuscular breast implants are placed under the chest muscle behind the breast. It is two-thirds covered by the muscle itself and the remainder is covered by the breast's connective tissue. The chest muscle can accommodate this because it's connected to the chest wall along the muscle's outer perimeter, creating a natural pocket where the implant is inserted.

Implants placed under the muscle tend to create a better and more natural look. Since the implant is concealed underneath the pectoral muscle, ripples or the edges of the implant are covered. This tends to produce a more attractive appearance and feel to the breasts. Because the implant is behind the muscle, interference during mammograms is unlikely. The breast tissue can be easily checked. More importantly, implants under the muscle are not prone to capsular contracture.

Compared to subglandular implants, recovery may be prolonged and be more uncomfortable. This discomfort is due to the manipulation involved in positioning the implants underneath the muscle tissue.

It is important to discuss your concerns regarding implant placement with your board certified plastic surgeon prior to your procedure. Placement may be determined based on your body type, preference, and/or lifestyle. Many women desire a more natural look and feel and therefore, prefer to choose placement under the muscle.