The decision regarding breast implant placement involves choosing between two primary surgical planes: subglandular and submuscular. Subglandular placement positions the implant on top of the pectoralis major chest muscle, beneath the existing breast tissue. Submuscular placement involves creating a pocket either partially or fully underneath the chest muscle. This choice is highly individualized, presenting unique benefits and trade-offs concerning appearance, recovery, and long-term maintenance.
Differences in Appearance and Feel
The placement depth significantly influences the final look and feel of the augmented breast. Placing the implant in the subglandular plane, over the muscle, often results in a more pronounced fullness in the upper part of the breast. This position allows the implant to sit closer to the surface, creating a more dramatic contour and cleavage line. Subglandular implants also tend to move more naturally and synchronously with the body’s movements.
However, the lack of muscle coverage in the subglandular plane can be a disadvantage, particularly for individuals with minimal natural breast tissue or thin skin. In these cases, the edges of the implant may be more visible (palpability), or the implant shell may show visible folds (rippling). The muscle layer in submuscular placement acts as a cushioning layer, concealing the implant and providing a smoother transition from the chest wall to the breast mound. This additional coverage results in a more gradual, natural-looking slope in the upper breast, often preferred for a less augmented appearance.
A drawback specific to submuscular placement is the potential for animation deformity, which occurs when the pectoral muscle contracts. Activities that engage the chest muscles, such as pushing or lifting, can cause the muscle to pull on the implant, resulting in a temporary distortion or shifting of the breast shape. This phenomenon is noticeable in patients who are highly active or engage in frequent upper-body strength training. Subglandular placement avoids this issue entirely because the implant is not affected by the muscle’s movement.
Recovery Time and Post-Surgical Pain
The manipulation of the pectoral muscle during surgery directly impacts the acute post-operative experience, with submuscular placement typically involving a more challenging recovery. Creating the pocket beneath the muscle requires the surgeon to lift and stretch the muscle fibers, which causes significantly more initial pain and tightness. Patients who choose the submuscular approach often require stronger pain management in the first few days following the procedure.
The recovery time is consequently longer for submuscular implants, as the manipulated muscle needs additional time to heal and for swelling to subside. Returning to light activities and non-strenuous work may take longer than the subglandular approach. Conversely, subglandular placement is associated with a shorter recovery period and less discomfort because the muscle is left undisturbed. Patients often experience less post-operative soreness and may return to their normal daily routines sooner.
Long Term Medical Considerations
Implant placement affects several long-term health and maintenance aspects, most notably the risk of capsular contracture. This condition involves the tightening of the scar tissue capsule that forms around the implant, which can cause the breast to feel hard, change shape, and become painful. Submuscular placement is consistently associated with a lower incidence of capsular contracture, with some studies suggesting the risk may be reduced by more than half compared to subglandular placement. This reduction is theorized to be due to the protective effect of the muscle, which may improve blood flow and prevent excessive scar tissue formation.
The chosen plane also affects the ease and accuracy of routine breast cancer screening. Breast implants, regardless of placement, can obscure some breast tissue on a standard mammogram because X-rays do not penetrate the implant material easily. For all augmented patients, specialized imaging techniques, such as implant displacement views, are required to push the implant back and pull the breast tissue forward for better visualization.
Submuscular implants generally interfere less with the mammographic visualization of the breast tissue, making it easier to see the posterior aspects of the breast. However, both placements necessitate that the imaging facility is experienced in screening augmented breasts to ensure a thorough examination. While submuscular placement may offer a lower long-term complication rate, subglandular placement can sometimes simplify future revision surgeries if the implant needs to be replaced or removed.
Determining the Best Placement for You
The optimal implant placement is ultimately determined by a combination of the patient’s existing anatomy and their aesthetic and lifestyle goals. Individuals with minimal existing breast tissue or a very lean body type are frequently better candidates for submuscular placement. The muscle provides the necessary extra layer of coverage to camouflage the implant edges and prevent visible rippling.
For patients with a greater amount of native breast tissue, or those who desire maximum upper pole fullness, subglandular placement may be the more suitable choice. Furthermore, a highly active lifestyle, particularly involving regular weightlifting or strenuous chest exercises, often makes the subglandular plane preferable to avoid animation deformity. A thorough consultation allows a surgeon to measure tissue thickness, discuss activity level, and assess the desired size increase based on the patient’s unique physical characteristics and long-term expectations.