Implant Placement

Obviously, all implants are placed in the breast tissue. However, a distinction is made depending on the exact location of the implant and its relationship to the pectoralis muscle in the chest. There are actually three potential placement sites for the implants: subglandular, partial sub muscular, and complete sub muscular. Each location has its advantages and disadvantages that must be heavily weighed before making this personal decision. The outcomes will vary from patient to patient depending on the amount of breast tissue present, type of implant used, skill of surgeon, as well as other factors.

Subglandular (Below the glands)

Theoretically all three locations are subglandular because all of the implants are placed under the breast glands. However, what makes this procedure different than the other two is that the implants are placed on top of the pectoral muscles in the chest. This procedure is also referenced as overs, retro glandular and sub mammary. As with any decision, there are pros and cons.

The benefits of a subglandular placement are mostly contributed to the fact that the muscle has not been disturbed. These benefits include a shorter surgery time, less recovery time, and less pain. Implants will sag in tandem with the breasts, so a double bubble is not the result. Also, because the implants are not behind the muscle, they will be more accessible for the inevitable reoperation due to either their replacement or removal. This lack of concealment also contributes to several disadvantages. For instance, overs are more palpable and potentially visible depending on the amount of breast tissue of the patient. The more breast tissue the less chance one has to see or feel the implant. Subglandular placements also make for more difficult mammogram readings because the implant obscures some of the glands. Additional views are necessary and insurance wont always pay for them. Also, capsular contracture, a common complication, is more likely to occur in subglandular placements.

Partial Submuscular

In this scenario, most of the implant is placed behind the pectoralis muscle. It is called partial submuscular because actually the lower one third of the implant is not under the muscle as seen in the diagram. This placement is also known as partial-under or partial sub-pectoral. The advantages and disadvantages of this method are just the opposite of the subglandular placement. First of all, because the implants are placed under the muscle, surgery is more invasive making surgery and recovery longer. With the partial submuscular placement, there may be a higher chance of bottoming-out because the lower 1/3 of the implant is only supported by skin.

Also, implants may appear distorted while flexing. On the other hand, the hidden nature of the implants makes them less palpable and less likely to create visible rippling. Mammography images are more easily read because the implant is not blocking any views of the glands, and there is a lower risk of capsular contracture. There is also the theory that implants placed under the muscle are more supported and are less likely to sag over time. A breast lift might be recommended in conjunction with a submuscular placement to avoid the implant being above or distinct from the rest of the breast. Partial under implants take longer to drop or settle, but over time they will appear more and more natural.

Complete Submuscular

There is often no distinction made between the partial and complete submuscular placements. Both are often generalized as under the pectoralis muscle which is located between the chest wall and the breast tissue. However, in the complete subglandular the entire implant is covered and supported by the pectoralis and serratus muscles in addition to the abdominus rectus fascia. This method is not widely used and cannot be placed through the navel. This placement is also referred to as complete-under, total sub-muscular, total sub-musculofascial, and full unders. Many of the pros and cons are the same as the partial- under. For example, just like with partial submuscular placement, the surgery takes longer, more recovery time is needed, and it is more painful because the muscle has been distressed.

Furthermore, the implant will be more difficult to access during either future replacement or removal of current implants. Because there is more support than just skin, the chance of bottoming-out is reduced. Although implants placed under the muscle are initially high, they settle to look very natural because the more natural tissue that covers an implant, the more natural it will look and feel. This natural cover reduces rippling and palpability.