Breast Augmentation with Submuscular Placement

Breast augmentation with breast implants is a cosmetic surgical procedure for women unhappy with their breast size or shape. Placement of the breast implant depends on the anatomy and health of the woman undergoing the procedure, and the surgeon.

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Subglandular vs. Submuscular Breast Implant Placement

The most common location for a breast implant in recent times has been mainly under the pectoralis major muscle, with some of the implant under the serratus muscles at the ribs and the rectus abdominis fascia of the abdomen. This type of placement is referred to as submuscular, while subglandular placement is under the breast tissue and subpectoral is under the pectoralis major muscle.

Submuscular placement in breast augmentation is preferred to subglandular placement as the possibility of capsular contracture is far less. Following breast augmentation surgery, breast implants are surrounded with a wall of collagen and myofibrils (a part of striated muscle fiber). This occurs naturally and gradually within the patient's body. However, this naturally formed capsule around the implant sometimes contracts, hardening the breasts in a phenomenon termed capsular contracture. The rate of capsular contracture occurring in submuscular placement is almost half of that of subglandular placement. Furthermore, since the implants are placed under the muscle, they are more hidden. As a result, they cannot be felt as easily while wrinkles and ripples resulting from the implants are minimized.

Submuscular placement is often chosen for women who require full breast reconstruction or are smaller breasted, since there is an insufficient amount of breast tissue to cover the breast implant.

Some drawbacks to submuscular placement should be noted. These include the possibility of a longer breast augmentation procedure, longer recovery time, and it may be more painful. Though the risk of some local complications are less, it can complicate reoperation.

After breast augmentation, the submuscular placement may result in the breasts moving not as naturally as before, as implants will be firmly planted behind the muscle wall. There may be minimal shifting of the implants during excessive movement (particularly when the muscles in the chest area contract). For this reason, athletes or patients who require the development of chest muscle prefer subglandular placement.

During the breast augmentation procedure, incisions made for submuscular placement can be below the breast, at the belly button or armpit, or around the areola.

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