Breast augmentation, or augmentation mammoplasty aims to increase the size, shape, or fullness of the breast with the help of silicone, saline, or alternative composite breast implants. The location selected for placement of breast implants is determined by several factors. They can be placed either partially under the pectoralis muscle (submuscular) or over the pectoralis muscle on the chest and under the breast tissue (subglandular). The goal is always to provide optimal long-term coverage of the implants and to avoid creating deformities which cannot be corrected, such as visible implant edges, wrinkles and rippling.

Both subglandular and submuscular implant positioning are acceptable for every type of implant, however, depending on the patient’s anatomy, lifestyle, preferences, and the particular implant chosen, one position may be preferred over the other. Breast implants are not natural, but are synthetic mechanical devices. They do not always appear or behave 100% naturally. Elementslike the skin elasticity and how much the skin stretches after surgery, affect breast augmentation results, but can be unpredictable and uncontrollable. The space developed behind the breast and perhaps behind the pectoralis muscle for implant placement is referred to as a “pocket” for the implant. The location and size of the pocket are important. Attention to detail during the procedure contributes to subtle aspects affecting the quality of the surgery outcome.

The popular technique for deeper placement of implants is to lift the lower part of pectoralis major muscle, develop a pocket for the implant beneath this muscle, and place the implant within the “submuscular,” or “subpectoral” pocket.This technique of breast implant placement results in a “dual plane” position, meaning the upper inner portion of the implant is beneath pectoralis muscle, while the lower outer portion, because it extends below the lower margin of pectoralis muscle, is beneath the breast gland. Submuscular or dual-plane placement of breast implants is recommended for women with thin breast tissue, as the edges of the implant will be well-concealed.  The edges of the implant will also be less likely to be felt. This method works well with saline or cohesive silicone gel implants. When a breast lift is simultaneously performed, submuscular implant placement improves blood supply to the overlying breast.

In the subglandular position, the implant is placed in a pocket behind the breast gland, entirely on top of the pectoralis major muscle.  If the breasts are slightly sagging, subglandular placement offers a lift effect unrestricted by overlying muscle. Subglandular placement avoids disturbing implant “animation.” Animation is breast implant movement caused by arm movement and contraction of the pectoralis muscle. This technique is especially suitable for women who compete athletically or who are very active with their upper body. Subglandular placement of breast implants under the breast tissue is generally not advised for women with thin tissues, as the implant edges may become more visible.  In addition, the implant itself may show rippling, and the edges can sometimes be felt.  Mammograms are more difficult to perform with implant placement beneath the breasts.  There is a higher risk of capsular contracture, or scar tissue formation, around the implant following subglandular placement.

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