Submuscular Placement & Subglandular Placement
Breast Augmentation surgery involves the enhancement of a woman’s breasts by placing an implant in the chest either under the breast tissue or under the Pectoralis Muscle. Placement of your breast implants depends on your anatomy, health, and expectations of the surgery.
This can be best assessed and decided upon during a complimentary consultation with a surgeon at Toronto Cosmetic Clinic (TCC).
Breast Implants Over the Muscle
“Over the Muscle” placement refers to the implant being placed in front of the Pectoralis Muscle. This can also be referred to as a Subglandular placement, as the implant is placed under the breast tissue. Since the placement of the breast implants is in the same area as the existing breast tissue, the Subglandular technique appears more natural than “Under the Muscle” (Submuscular) technique.
Patients may not require general anesthesia during a Subglandular Breast Augmentation surgery. Rather, in most cases, only local anesthesia is used, accompanied by sedation delivered intravenously. Not only does using local anesthetic eliminate the increased risks associated with general anesthesia, but also the duration of the procedure is shortened, as no incision is made into any of the existing muscles in the area. Normally, the only incisions made in Subglandular placement are into skin and fat as opposed to muscle. This reduces the amount of pain and bleeding following Breast Augmentation surgery.
Over the Muscle placement was actually the original method used in Breast Augmentation surgery, though it is less common today.
Breast Implants Under The Muscle
Under the Muscle placement refers to the implant being placed behind the Pectoralis Muscle. This can also be referred to as a Submuscular placement.
Under the muscle placement is often chosen for women who require full breast reconstruction or have naturally smaller breasts as there is an insufficient amount of breast tissue for Subglandular placement. Furthermore, since the implants are placed under the muscle, they are more hidden. As a result, Submuscular breast implants cannot be felt as easily while wrinkles and ripples are minimized.
During the Breast Augmentation procedure, incisions for Submuscular placement can be made below the breast, at the belly button or armpit, or around the areola.
Some drawbacks to Submuscular placement should be noted, however; they include the possibility of a longer Breast Augmentation procedure, extended recovery time, and the risk of more pain and bleeding. Though the overall chances of certain complications (i.e. wrinkling, capsular contracture) are lessened, the placement can also make for a more complicated reoperation.
Over the Muscle vs. Under the Muscle Placements
|Over the Muscle||Under the Muscle|
|Capsular Contracture Risk||Slightly Less||Slightly More|
|Popularity Amongst Patients:||Less Popular||More Popular|
Submuscular placement (under the Pectoralis Muscle) in Breast Augmentation is sometimes preferred to subglandular placement (under the breast tissue) as the possibility of capsular contracture is far less. Following Breast Augmentation surgery, breast implants are surrounded with a wall of scar tissue, collagen, and myofibrils (a part of striated muscle fiber). This occurs naturally and gradually within the patient's body. However, this “capsule” around the implant sometimes contracts and tightens around the implant, hardening the breasts in a phenomenon known as capsular contracture (symptoms include hard, painful, abnormal looking breasts). The rate of capsular contracture occurring in submuscular placement is almost half of that in subglandular placement.
Over the Muscle breast implant placements result in a more appealing cleavage line, as the breasts are also naturally lifted. Implants can also be examined more easily since they are not hidden by muscle. Unfortunately, under the muscle placement may not be an option for women with smaller breasts and less breast tissue. Due to their natural lack of breast tissue, the outline of breast implants will be easily visible and may appear unnatural following Breast Augmentation surgery. Therefore, over the muscle placement is usually preferred for women with such physiology.
Furthermore, since the implants are placed under the muscle, they are more hidden. As a result, submuscular breast implants cannot be felt as easily while wrinkles and ripples are minimized.
After Breast Augmentation, the Submuscular placement may result in the breasts moving less naturally than prior to surgery as implants will be firmly planted behind the muscle wall. The implants may also shift slightly during excessive movement (particularly when the muscles in the chest area contract). For this reason, athletes or patients who require the development of chest muscles prefer subglandular placement.
Detecting breast cancer may be more difficult with over the muscle placement as the implants can shield some breast tissue. While this is true for under the muscle placement as well, there is a possibility that more tissue can be hidden with over the muscle. It is important that women with either placement visit a specialist experienced in dealing with breast implants during routine mammograms.