Breast augmentation is a leading body contouring procedure praised for its ability to enhance the size, shape, and symmetry of the breasts using carefully-selected breast implants. These medical devices are made using saline or silicone gel, which is an important choice associated with the final outcome of the procedure. Another detail that patients must consider, and one that also affects the appearance of the breasts, is the placement of the selected implants. The options are to place the implants beneath the breast tissue (subglandular) or beneath the pectoral muscle (submuscular). Here, we discuss each option so that you come to your consultation with the best possible information at hand.
Subglandular breast implant placement is done beneath the mammary gland and the breast mound but over the pectoralis major muscle. Aesthetically, the subglandular placement may be more pleasing to some people. This is because situating the implant in what is called the retromammary space aligns very closely with the natural expansion of the breasts. When the breasts grow larger naturally, the fatty tissue is all above the pectoralis muscle. So, in this way, it makes a lot of sense to place a breast implant above the muscle rather than beneath it. However, we must also remember that breast implants are not exact replicas of natural breast fat. While the subglandular placement may be optimal for creating more cleavage, there are disadvantages that may outweigh that singular reward. Because breast implants are not replicas of natural fatty breast tissue, the appearance created by subglandular placement may seem to be unnaturally round for some patients. Something to keep in mind about the issue of appearance is that this is highly subjective. The best way to discern which placement you may prefer on an aesthetic level is to look at Before and After images. Despite the benefit of being less invasive and more aesthetically organic, subglandular breast implant placement is not the preferred method of most plastic surgeons. According to data, this placement has a higher risk of unpleasant side effects. For example, saline breast implants that are placed above the pectoralis muscle may create a rippling effect that is seen through the skin. Studies also indicate that there is about a 30% incidence of capsular contracture with subglandular breast implants. The incidence of this complication is only 10% with submuscular placement.
Submuscular Placement The majority of breast implants are placed beneath the pectoralis major muscle and above the pectoralis minor muscle. To fully cover the implant, the surgeon may resuture the pectoral muscle after insertion. This technique is believed to reduce the chances of capsular contracture. Beneath the muscle, the breast implant is far less likely to create any visible rippling and is also less likely to “bottom out. “Bottoming out” is the complication in which the breast implant falls below the nipple. While breast implants first appear higher on the chest wall after submuscular placement, it takes only a matter of weeks for the tissue to settle around them, allowing them to relax into a beautiful, natural-looking position. Placing breast implants beneath the pectoral muscle carries fewer risks for complications but the procedure itself does usually take longer than subglandular placement. It may take slightly longer to recover from breast augmentation in which the implants are placed under the muscle, as well, but patients are typically ready to go back to work within a two-week period. Patients whose jobs are more physically demanding may need to arrange more time off to allow the muscle to heal completely.
Breast augmentation surgery requires a lot of thought and decision-making during the consultation and planning phases of care. Dr. Walden is proud to have Dr. Atencio as a member of our team. Her training and experience as a breast surgery specialist are coupled with a kind and caring attitude that puts our patients at ease. If you would like to learn more about breast augmentation, contact our Austin office at 512.328.4100 to schedule a consultation.