Implant placement is a significant decision in breast augmentation. The implant’s position, whether over or under the chest muscle, substantially impacts the final aesthetic outcome, recovery, and feel. Understanding the differences between these placement options is a key step for anyone considering this procedure.
Subglandular Placement
Subglandular placement, or “over the muscle,” positions the breast implant directly behind natural breast tissue and in front of the pectoral muscle. This technique is less invasive because it does not disturb the chest muscle.
A key advantage of subglandular placement is a potentially shorter, more comfortable recovery. Patients often experience less post-operative pain and swelling, leading to a quicker return to daily activities. This placement can also result in a fuller upper pole and more defined cleavage for individuals with sufficient natural breast tissue. For highly active individuals, subglandular placement is preferable as implants do not move or distort when chest muscles contract.
Subglandular placement has certain considerations. In patients with minimal natural breast tissue or thin skin, implant edges might be more visible or palpable, and rippling could be more noticeable. There is also a slightly higher risk of capsular contracture, where scar tissue around the implant hardens. Additionally, mammograms and breast examinations can be more challenging to interpret with implants in this position.
Submuscular Placement
Submuscular placement, or “under the muscle,” positions the breast implant partially or entirely beneath the pectoralis major muscle, the large muscle in the chest. This technique provides additional coverage using the patient’s own muscle tissue. A common variation is “dual plane” placement, where the upper portion of the implant is under the muscle, and the lower portion sits over the muscle behind the breast tissue. This hybrid approach combines benefits from both subglandular and submuscular techniques.
Submuscular placement provides enhanced camouflage for the implant, leading to a more natural breast shape, particularly for individuals with thinner breast tissue. Muscle coverage helps reduce the visibility of implant rippling or wrinkling. This placement has also been associated with a lower risk of capsular contracture. The dual plane technique can create a smooth, natural slope and a fuller appearance in the lower breast pole.
Despite its advantages, submuscular placement can result in more initial discomfort and a longer recovery compared to subglandular placement, as the chest muscle is manipulated. Some individuals may experience “animation deformity,” where implants move or distort when pectoral muscles contract, which is more common with this placement. While dual plane aims to mitigate some issues, it is a more complex procedure.
Factors Guiding Placement Choice
The choice between subglandular and submuscular implant placement is a personalized decision made collaboratively with a plastic surgeon. Several factors are considered to achieve optimal, tailored results. Existing breast tissue thickness is a key consideration. Individuals with ample natural breast tissue may have sufficient coverage for subglandular placement, while those with minimal tissue often benefit from the added camouflage of submuscular placement.
The amount of natural fat present also influences the choice, as a greater fat layer can provide additional soft tissue coverage. The desired aesthetic outcome is also a factor; patients seeking a soft, natural look might lean towards submuscular placement, especially with limited natural tissue. Conversely, those prioritizing quicker recovery or who are highly active might consider subglandular.
A patient’s overall body type, including chest wall anatomy and shoulder width, helps determine how an implant will sit and project. Lifestyle considerations, such as participation in intense physical activities involving pectoral muscle contraction, are also discussed. The surgeon’s expertise and experience with different techniques guide the recommendation. Ultimately, the choice prioritizes patient safety, comfort, and the most natural-looking, long-lasting result.