Plastic & Cosmetic Surgery

Subglandular vs. Submuscular Placement: Which Is Better?


Subglandular When it comes to breast augmentation, women primarily have two important options from which to choose regarding placement: whether to have implants placed beneath the muscle (sub muscular placement “under”) or above the muscle (subglandular placement “over”). Choosing the best option for your body helps to ensure your desired breast augmentation results.

Submuscular Placement Advantages

Placing an implant beneath the pectoralis major muscle to cover the implant is what plastic surgeons refer to as a submuscular placement. Many surgeons feel submuscular placement helps reduce the likelihood of capsular contracture, although not all doctors agree. Submuscular placement also can reduce the chances of visible implant ripples after surgery, which may occur in women with less breast tissue for coverage.It has also been felt that may minimize visualization of the breast tissue during a mammogram. Submuscular placement will soften upper pole fullness especially in those patients with minimal breast tissue or in particularly thin patients.

Subglandular Placement Advantages

Subglandular placement occurs when the surgeon places the implant beneath the mammary gland but above the pectoral muscles. Women who have a generous amount of natural breast tissue generally are better candidates for subglandular placement. In such instances, subglandular placement can provide a more natural look while making the most of your natural assets. Subglandular placement will optimize and enhance upper breast fullness (if desired) while achieving the greatest “filling” of atrophic (sagging, pseudo-ptotic or “deflated”) breasts. Placing implants over the muscle will minimize the distortion seen with muscular contraction when implants are placed under the muscle.

A Brief Word about Subfascial and Dual Plane

Subfascial placement is accomplished by placing the implants under a thin layer of tissue that intimately covers the muscle. In this location it will be under the fascia but over the muscle. It claims to achieve the advantages of both subglandular and submuscular insertion. In reality, this tissue varies greatly among individuals and is quite difficult to raise as an intact structure. This commonly results in an outcome that is closer to a subglandular result.

Dual plane placement involves dissection both above and below the muscle. The former is typically used to rearrange or redrape the breast tissue especially with constricted (tuberous “tubular”) breast deformity, but then the implants are placed under the muscle. Essentially, one operates in both or “dual” planes.

The Best Choice for You

Of course, there are potential drawbacks to each breast implant placement option as well. For example, women who are very active may be less likely to see fully positive results from submuscular placement, while subglandular placement oftentimes produces less natural-looking results in slender, smaller-breasted women.

Making the right choice ultimately rests with the patient, who has a much better sense of what her body needs and can make fully informed decisions after consulting with a skilled breast augmentation specialist.

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