Summary: Debating over implant placement is one of the major decisions women face when it comes to breast augmentation. While most of the world leans toward subglandular placement, patients within the United States (and U.S. plastic surgeons as well) seem to prefer submuscular placement instead. Does submuscular placement really deliver superior results?
Before discussing the pros and cons of submuscular placement specifically, it’s important to understand how the different breast implant placement options compare.
- Subglandular placement: The implants are placed below the natural breast tissue, but above the muscle. Subglandular placement often means a more comfortable early recovery. This option is better suited for women who have a moderate amount of existing breast tissue (usually B cup or larger) so that the implants are not visible or palpable after surgery.
- Submuscular placement: Implants are placed below the chest (pectoralis) muscle. This placement carries a statistically lower risk of developing early capsular contracture compared to subglandular placement. Initial recovery may feel more painful at first and the implants can take longer to drop, since the muscles take longer to adapt to new contours than softer glandular breast tissue.
- Dual plane placement: Sometimes also called partial submuscular, in this placement the implants are positioned so that the top two-thirds are covered by muscle, while the bottom third is only covered by glandular tissue. This placement promotes a very natural settling of the implant through the lower pole of the breast.
More rarely, plastic surgeons may also use what’s called subfascial placement, in which the fascia is separated from the pectoralis muscle and the implant is placed between these two layers. However, the concern here can be that the thin fascial layer offers such minimal support that long-term results differ very little from subglandular placement.
Submuscular Pros and Cons
So why are so many patients opting for submuscular placement these days? Quite simply, women want to get the best breast augmentation results possible, and submuscular placement typically offers those results, especially in women who may not be ideal candidates for subglandular placement. In other words, women with smaller breasts and a slimmer build.
Less existing natural breast tissue and thinner skin can compromise the final aesthetics of implants placed subglandularly. Without sufficient cushion to lend a natural cover to the implants, edges may be seen or felt, along with potential implant surface ripples. Submuscular placement offers an additional layer of coverage by tucking the implant under the muscles as well. This creates a more natural-looking result in slender and/or small-breasted women particularly. Submuscular placement also offers greater long-term support thanks to the help of the fibrous chest muscles, so problems like bottoming out are minimized.
However, the tightness of the pectoralis muscles can mean that implants take longer to settle into their final position, and they may ride higher initially after surgery. The first few days of recovery can be more uncomfortable due to muscle tightness as well. Submuscular placement may also result in animation deformity, or implant displacement in response to muscle movement. This may be voiced as a concern for submuscular placement especially among more athletic women, although ensuring a complete muscle release during surgery can limit its occurrence.
Although placement is just one in a number of choices when it comes to breast implants, these decisions all have one thing in common: there is no single answer that’s right for every woman. The best approach toward breast augmentation is the one that best suits your body, and will deliver the most beautiful, natural results for you.