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Patients considering breast augmentation have a number of choices. Patients must make choices in the categories: 1) the location of the incision –  in the fold under the breast, around the areolar border, or in the armpit areas, 2) the type of breast  implant – silicone gel or saline, rough or smooth surface, and a variety  of degrees of projection and shape, and 3) the location of the implant (subglandular -under the breast) or (submuscular – under the breast and the pectoral muscle).  At first glance it might seem that it would be more natural to place the implant immediately beneath the breast tissue.  After all, the operation is about enhancing the breast, not the muscle.  The reality is more complex.  In general, for patients with a relatively small amount of natural breast tissue, when the implant is just beneath the breast tissue (the subglandular plane), there will be an abrupt shadow in the upper part of the breast.  The breast that is created will tend to look top-heavy and unnatural.  This is particularly true in patients who select implants that are relatively large in comparison to the natural breast volume.  Also remember that the natural disadvantages of saline implants are more noticeable when they are in the subglandular plane.

Most of the patients who undergo breast augmentation at the Whole Beauty® Institute choose to have the implant placed in the space beneath the pectoral muscle.  This is called submuscular breast augmentation.  During the consultation I review with the patient the advantages of this location. This location can provide a more natural look to the upper part of the breast, allow for greater ease in getting good quality mammograms, and lower the likelihood of hardening around the breast implant (known as capsular contracture).  Although it takes a little longer to create a proper space under the muscle, it is well worth it from the patient’s perspective.

There are some disadvantages to placing the breast implant under the muscle.  For the first few days the recovery from surgery is a little more uncomfortable.  Also for highly athletic patients, especially body builders, contraction of the muscle will cause a temporary distortion of the breast shape.  For most patients these are minor disadvantages when compared to the advantages.

There are some patients for whom subglandular breast augmentation may be a reasonable consideration.  Patients who are body builders may find that the subglandular plane works best.  Also patients with a fair amount of natural breast structure who want to round out the upper portion of the breast many find this to be a reasonable choice.  Also, with certain breast shapes, the subglandular plane may work best when a breast augmentation is combined with a mastopexy (breast lift).

If you have small breasts and you encounter a surgeon who suggests placing a large implant in the subglandular plane, run the other way!  This is the closest thing possible to a guaranteed return trip to the operating room to fix the problems that will result from this.  Unfortunately, there are a number of implant “mills” where the emphasis is on speed of surgery rather than on producing a good long term result.  The patient who thinks she has found a “bargain” at such places doesn’t factor in the cost of repeated surgery to correct the problems that result from the first surgery.