Subglandular Breast Augmentation

Subglandular breast augmentation, sometimes called retroglandular or submammary breast augmentation, is most suitable for breasts which are saggy and lacking in volume.

This procedure involves placing a breast implant above the pectoralis major muscle of the chest, there is however, some debate amongst plastic surgeons as to whether more effective results can be obtained by placing implants underneath the pectoralis muscles as occurs with submuscular or subpectoral (dual-plane) breast augmentation surgery.

As with all forms of plastic surgery, different surgeons have different preferences as to how they feel that a procedure should be done. But providing you go to a well-trained and experienced cosmetic surgeon, ideally one who specializes in breast surgery, the subglandular technique can be just as effective as any other technique in helping to transform your breasts into better proportioned, fuller and more attractive looking breasts.

Most surgeons though, will give their patient a choice as to the type of procedure they would like to undergo. This is why it is a good idea to familiarize yourself with the different types of surgical techniques available, as by doing so, you will then be able to pick the one that is most suitable for you.

But in some cases, this may not always be possible, as all procedures have their limits as to the type of results that they can produce. So ultimately, the type of procedure that you eventually have done will be determined by the results you hope to achieve, the current condition of your breasts and your preference for a particular surgical technique.

How Does Subglandular Breast Augmentation Work?

To carry out this procedure, the cosmetic surgeon will place the breast implants on top of the pectoralis muscles so that the implant sits underneath the glandular tissue of the breast.

For sagging breasts, a subglandular insertion can help to achieve a fuller and more natural looking result when compared to other breast augmentation techniques. This is largely because the surgeon can place the implant lower and center it behind the nipple.

Placing implants higher is generally not desirable for sagging breasts, because doing so may cause the breast tissue to droop over the bottom of the implant making the breast look unnatural.

Types Of Incisions

To minimize the eventual scarring that develops, most techniques use saline breast implants because they can be inserted into the breast and then later filled with saline to the desired volume. This means that a smaller incision is required than if a surgeon were using a silicone gel based implant. Gel based breast implants still can be used however, if that is the patients preference.

Although there are many different ways that an implant can be inserted into the breast, the most common methods involve making an axillary, periareolar or inframammary incision.

Periareolar Incision

A periareolar incision involves making a semi-circular shaped incision along the outer edge of the bottom half of the areola complex underneath the nipple.

One of the main advantages of this type of incision is that the resulting scar will blend into the areola border leaving very little sign that the breast has been surgically enhanced. A periareolar incision also allows the surgeon precise control over where they place the implant, which can result in better shaping of the breasts and less risk of asymmetry developing.

There is a risk however, that this procedure could affect a woman’s ability to breastfeed and so it may not be suitable for women who intend to have children at some point in the future.

Inframammary Incision

An inframammary incision involves making a small horizontal incision underneath the breast in the breast crease or inframammary fold.

Although the actual incision is generally larger than that found with a periareolar incision, because it is made along the inframammary fold the natural hang of the breast will conceal the resulting scar from view.

Women with smaller breasts however, may have a more visible scar, although the scar itself should still be blended quite well into the natural crease of the breast.

As the surgeon is working so closely to the site of the implant destination, they have a great deal of control over how that implant is inserted and so the risk of suffering from asymmetry or irregularly shaped breasts is generally quite low in the hands of a good breast surgeon.

Trans-Axillary Incision

A Trans-Axillary incision involves making an incision under the arm in the armpit. A cavity is created underneath the skin using a special rod-shaped tool and then the implant is pushed into place from the arm pit to the desired location.

The main advantage of this technique is that because the surgeon is not operating directly around the breast, there will be no visible scarring of the breast skin. There will however, be scarring underneath the arm pit and this will be visible when the arms are lifted or raised.

The obvious disadvantage of using this technique is that because the surgeon is implanting the implant from the arm pit, they have less control over how that implant is positioned. This can subsequently increase the risk of asymmetry developing and tends to produce a wider cleavage than when other techniques are used.

Trans-Umbilical Incision

A Trans-Umbilical incision involves making a semi-circular incision along the upper outer edge of the belly button. A rod-shaped tool is then used to create a cavity underneath the skin that extends from the abdomen up towards the breasts so that the implants can be inserted and then inflated.

This type of incision can be well concealed within crease of the belly button and so the resulting scar is usually barely visible if the procedure has been done correctly.

However, as with a Trans-Axillary incision, because the surgeon is operating so far away from the implant location they have less control over the eventual result. So even though you avoid having breast implant scars on your breasts, you could end up with asymmetry that requires a revision augmentation surgery to correct.

How Long Does The Procedure Take?

Breast augmentation is a very common type of plastic surgery, and so most surgeons are well experienced in this procedure.

The operation itself may be carried out in a hospital or surgery center and generally takes about one to two hours to complete, although it may take slightly longer if the surgeon is performing an axillary insertion such as from the arm pits or from the belly button.

Subglandular breast augmentation is a less invasive procedure than submuscular augmentation and so general anesthesia may not be required. Instead, you may be given local anesthesia and an intravenous sedative.

Advantages Of Subglandular Breast Implants

A subglandular breast augmentation tends to be easier to perform than other types of breast augmentation procedures because the implant is insert above the pectoral muscle rather than beneath it with only skin and fat being cut.

This results in less trauma to the body and so recovery is generally quicker and less painful. Subglandular implants also tend to be better at creating cleavage than submuscular implants, especially in women whose breasts are naturally far apart.

Reduced Risk Of Asymmetry

Another advantage of this procedure is that by positioning the breast implant above the muscle it makes it much easier for the surgeon to control the end result, providing that they are not using an axillary incision method.

This reduces the risk of asymmetry developing and allows for the implants to be easily removed or replaced at a later date, such as if a revision surgery is required or if larger implants are desired.

Reduced Breast Movement

Placing implants above the pectoral muscles tends to result in less involuntary movement of the breasts when the chest muscles are flexed. This can be a problem for some women who undergo submuscular implantation and engage in athletic activities.

Sagging Breasts

In women whose breasts already display sagging or droop (ptosis), over the muscle placements tend to result in much more natural looking breasts. This is because when implants are placed under the muscle it can cause the breast to appear as though loose skin is hanging off a firm surface, thereby making the sagging appear worse.

Quicker Recovery

As this is a less invasive procedure than submuscular implantation, recovery generally occurs much faster and with less pain. The breasts also settle into shape quicker.

Summary

Above muscle implants are relatively easy and straightforward for a breast surgeon to carry out and also allow for the implants to be easily removed at a later date. As breast implants have a limited lifespan, at least 10 years, being able to remove the implants easily can be a major advantage if you need to undergo further surgery later on.

This type of implant insertion technique is most suitable for athletic women, women with sagging breasts or women who would like very large breast implants.

Disadvantages Of Subglandular Breast Implants

Although subglandular implants were for a long time the most commonly performed type of procedure, today submuscular implants tend to be much more commonplace.

The reason for this is that when a breast implant is placed above the pectoral muscle, there is a greater risk of the implant being seen underneath the skin at the sides of the breasts thus making it obvious that those breasts contain implants.

The implants themselves can also ripple underneath the breast, which again may become visible underneath the skin especially in women who do not have much breast tissue to cover up their implants.

Capsule Contracture

Studies have shown that the risk of capsule contracture tends to be higher with subglandular implants. This can result in scar tissue forming around the breast implant, contracting, hardening and then altering the shape of the breasts causing them to look irregular.

Sagging

When breast implants are inserted above the Pectoralis muscles, they receive less support and so the breast may become more vulnerable to premature sagging.

As all women’s breasts sag with age, premature sagging can result in a woman wanting breast lift surgery (mastopexy) at an earlier age than she normally would have considered.

Shape

When round breast implants are used, subglandular insertion may result in the breasts looking artificially round. Newer teardrop shaped implants can help to somewhat overcome this though. In addition, because the implant is placed close to the skin, the surface of the breast may feel artificially firm when depressed.

Medical Examinations

Implants placed underneath breast tissue can interfere with medical examinations of the breasts such as mammograms or self examination by hand.

Note: Magnetic resonance imaging (MRI) scans will overcome any interference of the implant as it can visualize 100% of the breast.

Summary

The increased risk of capsule contracture, premature sagging and visibility of the implant beneath the surface of the skin have made above muscle implants a far less common procedure than they once were. Unless you are an athlete or have very sagging breasts, you would most likely be better off getting a submuscular implant.