Subglandular placement refers to placement of breast implants under the skin, fat, and breast tissue, but on top of the muscle. As a result of this, patients who are thin, and lack significant breast tissue will have an increased chance for implant palpability. The risk for capsular contracture is also significantly higher for both saline and silicone breast implants when placed over the muscle. The advantage to using this approach is the ability to take up loose skin at the lower poles of the breasts, and avoid the longer incisions necessary for a breast lift in some cases.
Submuscular placement puts the breast implant pocket between the ribs of the chest wall and the chest (pectoralis) muscle on top. It is much less prone to cause breast implant palpability than subglandular implant placement, and is associated with a lower risk of scarring and hardness around the implants. Its disadvantage is the propensity to cause a higher riding breast implant. When the pectoralis muscles are contracted the implants are also prone to move up in a very unnatural fashion.
The “dual-plane” approach allows placement of the upper portion of the implant under the muscle, and by releasing the lower portion of the muscle allows the lower portion of the breast implant to sit under the breast tissue. This eliminates the drawbacks of both the sub-glandular and sub-muscular placement while retaining the advantages of both. It is the most commonly performed placement in today’s breast augmentation surgery.
