Subglandular vs. Submuscular Placement
Breast augmentation is a surgical procedure that alters the size, shape, and texture of a woman’s breasts, usually through the use of implants filled with either a saline solution or a silicone gel. While the type of implants does impact the final outcome, their placement can be just as important.
Breast implants are most commonly positioned either directly under the breast tissue (subglandular placement) or under the pectoral muscles (submuscular placement). Each type of placement has its own advantages and disadvantages and your surgeon will help you decide which placement best suits your situation.
In the case of subglandular placement, the implant is placed beneath the mammary gland but above the pectoralis major muscle in what is known as retromammary space, which contains the loose areolar tissue that separates breast tissue from the pectoral muscles. This placement is typically considered the most aesthetically pleasing, as it most closely approximates the normal arrangement of breast tissue. Subglandular implants normally offer a more appealing cleavage line with a pronounced roundness to the breast. Furthermore, because subglandular placement does not involve the same deep tissue penetration as submuscular implant placement, surgical complications are generally reduced, surgery and recovery time are usually shorter, and it is possible to undergo the procedure under local anaesthesia only.
Disadvantages of Subglandular Placement
Despite its benefits, subglandular placement of breast implants has become increasingly uncommon, as it could lead to a number of complications and unpleasant side effects. When saline implants are used, a “rippling” effect can become more pronounced with subglandular implant placement, as the wrinkles of the underlying implant are more apparent through the skin. Furthermore, there is about a 30% incidence of capsular contracture, compared to a 10% incidence in the case of submuscular placement. Capsular contracture is a post-surgical complication caused by the body’s immune reaction to foreign material, wherein collagen capsules form and squeeze the implant and surrounding tissue, often causing pain, discomfort, and distortion. Capsular contracture often requires corrective surgery and/or implant replacement. In addition, some find subglandular placement less aesthetically pleasing than submuscular placement, as they find the roundness of the breasts looks unnatural. Because such judgements are highly subjective, before and after photos will be your best guide when determining which type of result you desire.
Breast implants are now most commonly inserted beneath the pectoralis major muscle and above the pectoralis minor muscle, in what is known as a submuscular placement. A variation of this placement, known as subpectoral placement, calls for the upper portion of the implant to be placed underneath the pectoral muscle, while the lower portion remains in a subglandular position. One drawback of this placement is the excessive movement of the lower portion of the implants compared with the upper portion, which may appear unnatural to some.
The Best Candidate for Submuscular Placement
Subglandular placement may not be an option for women with very little existing breast tissue, such as women with smaller breasts or those undergoing reconstructive surgery following a mastectomy. In cases where there is insufficient tissue to adequately cover the implants, submuscular placement is usually preferred. In addition, subglandular placement of implants may make routine mammogram screening more difficult, and patients are advised to see a specialist experienced with performing mammograms on patients with breast implants.
Advantages of submuscular placement
A conventional submuscular placement calls for the resuturing of the pectoral muscle after the insertion of the implant, allowing full coverage of the implant by the pectoral muscle and surrounding connective tissues. This placement reduces the risk of post-surgical capsular contracture. In addition, because submuscular placement offers better implant coverage, the “rippling” effect sometimes noticeable in saline implants is far less pronounced. Moreover, the extra coverage and support granted by submuscular placement reduces the chances that the implants will “bottom out,” which may occur when the implants fall too low while the nipples remain high. Submuscular placement is appropriate for women with less breast tissue. Unlike subglandular implant placement, submuscular implants are less likely to interfere with mammography results. While submuscular implants may initially sit higher on the chest, they should descend gradually into a more natural position as the body adapts and swelling begins to settle down.
Disadvantages of Submuscular Placement
While submuscular placement is generally preferred due to its reduced risk of post-surgical complications, the procedure typically takes longer, and revision surgeries may be more complicated. Furthermore, recovery time may also be extended, and patients may experience more pain and discomfort following their breast augmentation procedure. Despite the reduced risk of post-surgical complications, some people find submuscular placement less aesthetically appealing than subglandular placement. For example, the breasts may not move or feel as “natural” as in subglandular implant placement. In addition, muscular flexing may interfere with the position of the implants and cause distortion that may be visually apparent, and many athletes choose subglandular placement, which won’t cause the breasts to change position during workouts.
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Ultimately, each type of placement has its own advantages and disadvantages, and is suited to different situations. Your surgeon will be able to make a detailed recommendation based on your individual circumstances.