The final outcome of a breast augmentation is due in large part to the placement of the breast implant. The continued debate of implant placement over the muscle or under the muscle is not often clearly understood by women seeking to have this procedure done. The good news is that in the past several years there are more options for breast implant choices and implant placement than there has ever been.

Besides choosing either a silicone or saline implant, one of the biggest decisions is the placement of the implant itself, since this will determine the way the breast will project itself after the surgery. Placing the breast implant above the muscle or sub-glandular, produces a more rounded, fuller on top look, which even though looks less natural, many women prefer.

Some of the benefits of a sub-glandular implant placement are:

• Produces a round augmented look in the patient
• The implants are placed inside the breast tissue – which is an advantage to the surgeon
• Less recovery time post-operatively since only skin and breast tissue are cut and displaced and not muscle.
• The ability to place oversized implants – which some women want.

Some of the disadvantages to the sub-glandular approach to breast implant augmentation are:

• Interference with ease of mammograms.
• Visible signs of the implant itself from showing through the skin – this is common for women with thin breast skin.
• Rippling of the implant when bending over.
• Increased chance of getting a capsular contraction.
• Increased rate of implant migration and losing the inframammary fold or breast crease.
• Increase probability of ptosis or the snoopy dog syndrome. This is where the breast nipple points down ward.

Some of the advantages of the sub-muscular approach to breast augmentation include:

• Minimizing the loss of the inframammary fold or migration of the breast implant.
• Less likely to produce ptosis
• Produces a more natural shaped look.
• Less chance of ripping or breast implant from showing through the skin.
• Lower capsular contracture rate since the implant does not come in contact with the milk glands.
• Low interference with mammograms.
• Good internal support for the breast implant.

Disadvantages of the sub-muscular approach to breast augmentation:

• Difficulty in mastering the technique by the physician – not all surgeons use this technique.
• Discomfort with the muscle post-operatively
• Longer time for recovery.

Most skilled surgeons prefer the sub-glandular approach to breast augmentation for a multitude of reasons as described here, however, it is important to get multiple opinions and do your research to determine for yourself what is best for you before scheduling your surgery.