A Complete Guide to Breast Augmentation Procedures

Board-Certified Plastic Surgeon Serving Baltimore, Columbia, Owings Mills, Towson, Nearby Maryland & Lower Pennsylvania

Posted: January 31, 2024
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Making an Informed Decision:

Breast augmentation surgery has undoubtedly gained widespread popularity, attracting attention from celebrities and everyday individuals alike. However, amidst the buzz and media coverage, it is crucial to separate fact from fiction when it comes to making an informed decision about the procedure. Contrary to popular belief, breast implants don’t necessarily need to be removed after ten years. With advancements in materials and proper care, implants can last far longer and may not require replacement for decades. Moreover, research and health regulations have shown that breast implants are safe and do not pose an increased risk of cancer or prevent breastfeeding. Choosing the right implant size is a personalized decision, guided by professional recommendations to achieve a beautiful and natural result. It is essential to consult with qualified surgeons, like Dr. Basner, who prioritize the health and safety of their patients.

Traditional Breast Augmentation Placement options:

Most patients aren’t even aware there are several options for the placement of breast implants. Traditional breast implant placement options include subglandular meaning over the muscle and submuscular placement meaning under the muscle.

1. Subglandular Implant placement

Subglandular, or over the muscle, placement is a technique in which the breast implant is positioned between the existing breast tissue areas and the chest muscle. The main objective of this method is to ensure the implant lies below the breast’s glands. Women with a higher amount of natural breast tissue (B cup or larger) are the most suitable candidates for this type of implant placement. Large amount of breast tissue provides better coverage for the implant and produces a more pronounced and rounded look.

If you have enough soft tissue coverage around your cleavage area, this placement will likely be the best option. The breast implant will be placed between the breast tissue and the pectoralis muscle.

Pros of over the muscle placement:

The main advantage of over-the-muscle implant placement is less movement of the implants or during physical activity. Also, it’s a relatively easier procedure than other types of implant placement. Surgeons can also use larger implants with subglandular placement.

Patients who undergo breast augmentation with this technique usually have less discomfort and faster recovery after the procedure. They recover faster because the chest muscle is undisturbed during the procedure. Swelling after breast augmentation subsides quickly, thus allowing breasts to “settle” to natural form and shape faster. When flexing the chest muscle, there is no chance of distorting the implant.

In summary – some of the benefits of subglandular placement are:

  • Rapid recovery
  • Enhanced breast cleavage
  • Reduced lateral malposition (widening of cleavage)
  • Improved shape with constricted breast or breast ptosis
  • Minimal risk of implant movement during activity

Cons of over the muscle:

When it comes to disadvantages, the look of your implants may seem more artificial with subglandular placement, particularly if the skin and breast tissue are of poor quality. The technique also increases the chance of visible implant rippling, especially in women with less breast tissue. That’s why this is not a suitable implant placement if you don’t have enough breast tissue.

Mammograms readings may also be less clear in patients who’ve undergone breast augmentation with the over-the-muscle implant placement method.

A complication called Capsular contracture is more prevalent in patients whose implants are placed over the muscle. Capsular contracture is when the body reacts to a breast implant in a way that can cause pain and distort the shape of the implant.

2. Submuscular Implant placement

Submuscular, or under the muscle, placement involves placing breast implant partially under your pectoralis major muscle, a thick fan-shaped muscle located at the chest.

In this procedure, the surgeon partly detaches the pectoralis major muscle from the bottom along the ribs. Then, the implant is placed right underneath. That being said, the pectoralis major is a relatively short muscle and is unable to cover the entire surface of the implant. It can only cover the top half of the implant, while your breast tissue covers the bottom half. The submuscular placement is a good option for women with a smaller amount of natural breast tissue (Smaller bra cup sizes). In women with little breast tissue, the muscle provides greater coverage over the implant. This will also lead to more natural results.

Pros of under the muscle placement:

Your breasts have a more natural look, a smoother shape, and more tissue coverage. The risk of capsular contracture is lower in women who’ve undergone under the muscle implant placement. The chance of visible rippling is low with this approach.

Mammograms also tend to be clearer in patients with submuscular placement because the implant is “out of the way”.

In Summary, some of the benefits of sub muscular placement are:

  • Natural upper pole of the breast
  • Reduced dropping (inferior malposition)
  • Less interference with breast imaging (mammogram)
  • Reduced visibility, palpability and rippling

Cons of under the muscle:

Generally speaking, this technique is associated with slightly more discomfort and a longer recovery period, as well as temporary loss of strength in chest muscle. That happens because this placement method involves incisions to the muscle. Since swelling takes longer to subside, it may take longer for breasts to settle into their natural form and shape.

Animation deformity is yet another uncommon but possible complication. Animation deformity happens when the implant moves upward and toward the axilla (an armpit) when a patient flexes the pectoral muscle, e.g. during exercise. This complication is rare but possible and more likely than in completely subglandular technique. The risk of rupture may also increase.

Other Implant Placement Options: Dual plane Implant Placement

A dual-plane, often referred to as partial submuscular placement, is a technique where your breast implant is partly behind the pectoralis muscle and partly behind the breast tissue. In this case, the layers of the breast from external to internal level are the skin, breast tissue, pectoralis muscle, and ribs.

As you can see, dual plane placement combines both subglandular and submuscular implant placement. To perform this procedure, a surgeon needs to detach the lower origin of the pectoralis muscle from the chest wall and separate it from the bottom part of the breast tissue. As a result, the muscle can slightly slide upward. When the implant is positioned, one part of it is covered by the muscle and the other by breast tissue. You probably noticed the dual plane is very similar to submuscular placement but an improved version.


The best way to find out which implant placement is the best for you is to schedule a consultation with Dr. Basner. During the consultation, he will perform a physical exam and discuss your expectations and goals to determine the most suitable approach for the best results.

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