When considering breast augmentation, a key decision made between you and board-certified plastic surgeon Gregory Wittpenn, MD is the location of the implant pocket. Subglandular (over the muscle) and submuscular (under the muscle) placement are the two primary options for implant placement and each technique has its own advantages and limitations. The best approach for you depends largely on your natural anatomy, lifestyle, hopes for the outcome, and long-term considerations. Below, our team explores essential pros and cons of each method to let you know what to expect and help you make an informed decision.
What is Over-the-Muscle Placement?
With subglandular placement, the breast implant is positioned directly behind the breast tissue but above the chest muscle. This approach is generally best suited for patients who have sufficient natural breast tissue to cover the implant, as it relies on the existing soft tissue for shape and coverage.
Pros of Subglandular Implant Placement
- Less healing time: One of the primary advantages of subglandular placement is a shorter, less painful recovery period as the chest muscle remains undisturbed during surgery. Patients often experience less postoperative discomfort and may resume normal activities more quickly.
- Less implant distortion with contraction of chest muscles: Additionally, since the implant sits above the muscle, it is less likely to distort or shift during chest muscle contractions — an important consideration for individuals who engage in weightlifting, bodybuilding, or other forms of upper-body training.
- Easier implant handling in the case of revision surgery: Another benefit is that subglandular placement may allow for easier implant positioning and adjustments during revision surgeries. This approach can also provide a more pronounced breast shape or cleavage, particularly in patients who already have some natural volume.
However, there are some notable disadvantages. Subglandular placement may result in more visible implant edges or rippling, especially in women with thin skin or minimal natural breast tissue. The risk of capsular contracture — a condition where scar tissue hardens around the implant — can also be higher with this technique when compared to submuscular placement. Moreover, subglandular implants may look less natural in some patients, particularly in the upper portion of the breast where there is less soft tissue coverage. There also may be greater risk for developing sagginess to the breast due to the weight of the implant pulling down.
What is Under-the-Muscle Placement?
Submuscular placement involves positioning the implant beneath the chest muscle, as well as under the overlying breast tissue. This technique is commonly recommended for women with smaller natural breasts or less soft tissue coverage, as the muscle adds an additional layer of protection and support over the implant.
Pros of Submuscular Implant Placement
- Reduced risk of implant complications: Extra tissue coverage from under-the-muscle placement helps camouflage the edges of the implant and reduces the likelihood of visible rippling. This technique is also associated with a lower risk of capsular contracture during breast surgery, making it a popular choice for long-term outcomes.
- Natural look: The biggest benefit of submuscular placement is that it typically offers a more natural-looking result, particularly in the upper portion of the breast. Another potential advantage is that submuscular implants may have a more gradual, natural slope, which many patients prefer. For individuals who are undergoing breast reconstruction or those who have little native breast volume, submuscular placement can create a more balanced and aesthetically pleasing contour.
On the downside, placing implants under the muscle involves a more complex surgical procedure and generally leads to a longer recovery period with relatively more discomfort. Patients may experience soreness for several days as the muscle adjusts, and movement can be more restricted initially.
Whether you opt for subglandular or submuscular placement, the ultimate goal is to achieve beautiful, natural-looking results that align with your lifestyle and self-image. Open communication with Dr. Wittpenn and a personalized treatment plan are essential to ensuring the best possible outcome.
At New Horizons Plastic Surgery, Dr. Gregory Wittpenn will guide you through every phase of the surgical process to help make the curves you envision a reality. Contact our Nacogdoches practice for more information about breast implant options or if you’re ready to schedule a consultation.