During breast surgery, breast implants can be placed either under the pectoral muscle or chest wall (submuscular implantation) or between the breast tissue and the chest muscle (subglandular implantation).
Most surgeons place breast implants under the chest muscle as this provides a better contour, especially in the upper part of the breast or the “cleavage” area, and offers a more natural shape in that region.
Additionally, this approach will flatten and improve the appearance of an implant in women who are thinner or require larger implants.
Also, breast cancer surveillance and mammograms after breast implants are easier to perform for implants placed under the muscle.
Advantages and disadvantages about implants
The subglandular placement of breast implants means that the implants are inserted closer to the surface, under the existing breast tissue but above the pectoral muscle.
A subglandular implant placed directly under the breast will appear “more like an implant” and will look fuller and rounder, especially in the upper inner area.
Additionally, it is easier in the short term to correct a “sagging” or ptotic breast with a subglandular implant (above the muscle) to try to avoid a breast lift. It can be very difficult to change from an above-the-muscle position to a below-the-muscle position later on.
Some believe that subglandular placement increases the risk of a condition known as capsular contracture, where scar tissue surrounding the implant tightens and compresses the implant, causing it to harden. In the case of capsular contracture, further surgery may be needed to remove the capsule tissue or replace the implant.
With submuscular implants, mammograms are easier to perform and read, and there is a reduced risk of capsular contraction. Depending on breast size and distribution of breast tissue, subglandular implants may be more noticeable.
Whether implants are placed submuscularly or subglandularly, it is almost the rule to feel the implants with the hands and, sometimes, even see their edges under the skin.
This happens if there is not enough breast tissue to cover them or in areas where tissue is less abundant, such as the lower pole. Saline implants are more likely to be seen in this way compared to silicone implants.
