Breast implant placement including submuscular, subglandular, and dual plane placement is an important part of the aesthetic outcome of your breast augmentation mammoplasty surgery, as well as the longevity of your results post-operatively. The decision of whether to opt for under the muscle, over, or somewhere in between will depend on many factors. These include your anatomy, aesthetic goals, and lifestyle. In this blog post, Dr. Phil Richardson—Brisbane Plastic Surgeon—provides a summary of the different options patients have when it comes to breast implant positioning. Dr. Richardson discusses the pros and cons of each positioning. We focus specifically on the ‘dual plane’ position to help patients better understand this technique.

Breast Implant Positioning

There are three main implant positions that are employed during breast augmentation mammoplasty here at Brisbane Plastic & Cosmetic Surgery. These implant positions include submuscular, subglandular, and dual plane. Each of these implant positions are unique, and serve to benefit different types of patients that may decide to have breast augmentation mammoplasty in Brisbane. To better understand which implant placement is right for you, we need to break down what each placement looks like, and their pros and cons.

Submuscular

Submuscular implants are implants that placed under the pectoral muscle and the breast tissue. The main rationale behind sub muscular placement is to provide greater coverage of the implant and to create a more natural “takeoff” that blends with the natural breast tissue. There are a number of pros and cons of under the muscle implant placement:

PROS:

• When smooth implants are used—which is all the time for Dr. Richardson—the capsular contracture rate for under the muscle placement has been found to be lower than other implant placements.
• Mammograms with under the muscle implants are more accurate according to anecdotal evidence from technicians and patients.
• There is a lower risk of implant visibility with a submuscular placement due to the additional coverage provided by the muscle.
• Under the muscle implants can provide a more teardrop look due to the compression of the upper-pole creating a more gradual, sloping “take-off” of the implant.

CONS:

• Under the muscle implant placement has a slightly longer breast augmentation mammoplasty recovery, and slightly greater discomfort following surgery due to the muscle interference.
• There is visible animation when patients are doing physical activity or using the pec muscles with a submuscular placement.

When do we use under-the-muscle implant placement?

Submuscular placement is often suitable for patients with little-to-no breast tissue, as implant visibility is more of a concern for these patients. Submuscular placement is also appropriate for patients having a breast lift mastopexy, as this approach optimises blood supply.

Subglandular

Subglandular implants refer to implants that are placed underneath the breast tissue, but on top of the pectoral muscle. This is “over the muscle” placement. The rationale behind an over-the-muscle placement is that it involves less interference and can create a more teardrop-shaped result for some women, while avoiding the risk of animation or visible distortion when activating the chest muscles. There are a number of pros and cons of over the muscle implants:

PROS:

• Patients see less animation during physical activity with over-the-muscle implants, as the pectoral muscle is not impacting the movement of the breast implant
• There is less discomfort during recovery, and recovery is often considered easier with over-the-muscle implants due to the lack of muscle interference during surgery
• Over the muscle implants can produce a very natural result for women with existing breast tissue.

CONS:

• There is a higher risk of implant visibility in patients with a subglandular placement, particularly with patients that have less breast tissue or poor skin integrity
• Over the muscle placement can impact mammogram views slightly.
• Over the muscle placement may increase capsular contracture risk.

When do we use over-the-muscle placement?

Subglandular (over-the-muscle) placement is more appropriate for patients that have existing breast tissue that will cover the implant edges. Over the muscle is particularly recommended for patients that are bodybuilders or train upper body regularly, as there is less animation of the breasts during workouts with a subglandular placement.

Dual Plane Implants

Dual plane placement is a lesser known implant placement, and is essentially a combination of both submuscular and subglandular options. In its simplest form, dual plane implants involve the upper pole of the implant being placed under the muscle and the lower pole of the implant sitting over the muscle, and under the breast tissue. The implant progresses from a submuscular to subglandular position. There are pros and cons to dual plane positioning:

PROS of Dual Plane Implants

• Many think that dual plane is the most natural implant position. This is due to reduced implant visibility in the upper pole, and greater fill in the lower pole to create a “teardrop” aesthetic.
• Dual plane implants provide greater support to the implant from the partial submuscular placement, reducing the risk of displacement.
• Dual plane allows the surgeon to tailor the implant placement according to the patient.
• Strategic dual plane placement can achieve a slight nipple elevation.

CONS of Dual Plane Implants

• Dual plane has a greater level of animation than under the muscle placement
• The dual plane procedure is more complex than subglandular or submuscular options.
• In patients with little-to-no breast tissue, dual plane placement may not provide the most appropriate coverage. Implant edges may be visible in the lower pole.

When do we use dual plane placement?

Dual plane placement is becoming more popular, and is generally preferred in situations of mild laxity or ptosis, constricted lower poles, and tuberous breast correction. Dual plane is generally appropriate to achieve a more teardrop-shaped look for patients with a moderate level of existing breast tissue.

How do I choose which implant position is right for me?

The decision of which implant placement is best for you will be the result of meaningful discussion with your plastic surgeon. It’s important to choose a surgeon that has extensive experience in all implant placements. Understand that each patient has an extremely unique anatomy! Choosing a surgeon that tailors their technique for breast augmentation mammoplasty will make a world of difference. Ask your surgeon why they recommend a particular implant position, and discuss the pros and cons of your alternatives.

Remember, the information contained in this article includes only general pros and cons of each implant placement. These are not hard and fast rules for every patient to follow. Educating yourself about the different aspects of breast surgery is important, but equally important is listening to the professional opinion of your surgeon and choosing an experienced plastic surgeon.

Conclusion

This blog has outlined a few of the key implant placements available to patients undergoing breast augmentation mammoplasty. It’s clear that there is no one-size-fits-all solution to implant placement. Patients should do their research to make the best decision for them. If you have any questions about breast augmentation mammoplasty, or any other cosmetic breast surgery – don’t hesitate to contact the Brisbane Plastic & Cosmetic Surgery team today. 

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