Where to Place the Implant in Breast Augmentation: Subglandular or Submuscular Placement
When a patient begins to consider breast augmentation, it’s normal for her first questions to be about the size, shape, or type of implant. However, there’s another decision that can have a significant impact on the outcome: where will the breast implant be placed?
As a board-certified plastic surgeon with over 20 years of experience, one of the things I most want my patients to understand is that there is no single implant position that is right for everyone.
The implant can be placed subglandularly, above the pectoral muscle, or submuscularly, below the muscle. We can also use techniques such as the dual-plane approach, which combines features of both positions.
To decide which is the best option, I evaluate factors such as each patient’s anatomy, the quantity and quality of breast tissue, the thickness of the overlying tissue, the dimensions of the chest, the size of the implant, and, of course, the result the patient hopes to achieve.
My goal is for the decision not to be based solely on the volume of the implant in cubic centimeters, but on how that implant will integrate with the body over the long term.
Breast Implants: Above or Below the Muscle?
The two positions we use most often are subglandular and submuscular. When we place the implant subglandularly, it sits above the pectoral muscle and below the breast tissue. In this case, the coverage of the implant depends mainly on the breast tissue and the tissues located above it.
With submuscular placement, the implant is positioned partially or completely beneath the pectoral muscle, providing an additional layer of coverage, especially in patients with little breast tissue.
There is also the dual-plane technique, in which we adjust the relationship between the muscle and the implant to achieve a more natural transition at the top of the breast while allowing the implant to occupy an appropriate position at the bottom.
Each option has advantages and potential disadvantages. For this reason, I do not recommend choosing an implant position solely because a technique is popular or because it has worked well for someone else.
Subglandular Implant Placement: Advantages and Disadvantages
One of the main advantages of subglandular placement is that the pectoral muscle does not directly affect the implant.
This can mean an easier recovery for some patients and prevents the “animation deformity” that can occur when the implant is placed under the muscle and the muscle contracts.
Furthermore, when a patient has sufficient breast tissue and suitable anatomy, this placement can allow the implant to blend very well with the natural shape of the breast.
However, not all patients have sufficient tissue coverage for this technique. In thin patients or those with little breast tissue, the edges of the implant or rippling may be more visible or palpable.
We must also consider that subglandular placement may be associated with a higher risk of capsular contracture and may make it more difficult to visualize breast tissue in some imaging studies. Therefore, the amount of available tissue is a very important factor when making this decision.
In patients who also have sagging breasts, augmentation can be combined with a breast lift. In these cases, the goal is not only to add volume but also to reposition the tissue and, when necessary, remove excess skin to improve the shape and position of the breast.
Submuscular Implant Placement: Advantages and Disadvantages
Submuscular placement has one major advantage: the pectoral muscle provides an additional layer of coverage over the implant.
This can be especially helpful in patients with little breast tissue, as it helps achieve a more gradual transition between the chest wall and the implant and may reduce the visibility or palpability of the implant’s edges.
It may also offer advantages in certain imaging studies and has been associated with a lower incidence of capsular contracture compared to subglandular placement.
However, placing the implant under the muscle also involves some considerations. Recovery may cause more discomfort initially, and in some patients, muscle contraction may temporarily alter the position or shape of the implant.
We call this an “animation deformity.” It may be more noticeable in patients who have strong pectoral muscles or who engage in activities that involve frequent chest muscle contraction. When the muscle contracts, the implant may shift or change shape in a visible way.
In certain cases, we may use a dual-plane technique, in which we strategically release a portion of the muscle to allow the implant to better conform to the shape of the breast and achieve a more natural position.
That is why, when I recommend submuscular placement, I do not do so simply because the implant is larger. The decision depends on the patient’s anatomy, tissue coverage, the size and characteristics of the implant, and the desired outcome.
Why Do Breasts Sag After Implant Placement?
This is one of the questions I hear most often in my practice. A breast implant has weight, and over time, the tissues that support it can also change. Aging, weight fluctuations, pregnancies, skin quality, and implant size can all influence the position of the breast over the years.
Therefore, no implant placement can completely stop the natural aging process of the tissues.
In some cases, over time it may be necessary to perform a breast lift, replace the implants, or adjust the pocket where the implant is located. This doesn’t mean the augmentation was a failure; it simply means that the body continues to change after surgery.
My recommendation is always to stay in touch with your surgeon and consult with them if you notice significant changes in the shape, position, or symmetry of your breasts.
What is the best option for breast implant placement?
The answer depends on each patient. For a patient with sufficient breast tissue and suitable anatomy, subglandular placement can be an excellent option. Among its advantages are a potentially easier recovery and the absence of implant movement associated with pectoral muscle contraction.
For a patient with less breast tissue, submuscular placement can provide additional coverage and help achieve a more natural transition at the top of the breast.
In other cases, a dual-plane technique may allow us to take advantage of the benefits of both positions.
That’s why, when a patient asks me which of the two options I recommend, my answer always begins the same way: first, I need to assess her anatomy and understand what result she is looking for.
During the consultation, I evaluate the dimensions of the chest, the amount of breast tissue, the quality of the skin, the position of the breasts, and other factors that may influence the outcome. Based on that assessment, we can choose the size, profile, and position of the implant that best suits her body.
For me, a successful breast augmentation isn’t simply about placing an implant. It’s about finding a combination that respects each patient’s proportions and achieves a natural, harmonious result.
Board-Certified Breast Augmentation Surgeon in California
Choosing a board-certified and experienced plastic surgeon is an important part of the breast augmentation process.
As a surgeon, my responsibility isn’t just to perform the surgery. It’s also to help you understand your options, explain the advantages and potential limitations of each technique, and guide you toward the decision that best suits your anatomy and goals.
At Ideal Plastic Surgery, we have a team of board-certified plastic surgeons and a medical staff that supports each patient before, during, and after their procedure.
If you’re considering breast augmentation and aren’t sure whether subglandular or submuscular placement is right for you, schedule an evaluation consultation. Together, we can review your options and design a surgical plan tailored specifically to your body.
By: Dr. Pirko | Ideal Plastic Surgery
