Breast augmentation remains one of the most popular cosmetic surgical procedures, with over 300,000 procedures performed annually in the U.S. and consistently high patient satisfaction rates. When considering breast augmentation, one of the key decisions involves implant placement. The three main options are submuscular (under the pectoral muscle), subglandular (above the muscle but beneath the breast tissue), and subfascial (above the muscle but beneath the fascia, a thin connective tissue layer). While submuscular placement has been the most common choice over the years, subglandular and subfascial placements are regaining popularity due to advancements in implant technology and growing awareness of their benefits.

Sub-glandular Placement

Advantages

More tissue coverage; smoother upper pole transition; lower capsular contracture rate for smooth implants.

Disadvantages

Higher risk of animation deformity; potential for increased discomfort during recovery; risk of implant distortion with muscle contraction.

Sub-muscular Placement

Advantages

No animation deformity; quicker recovery; less painful.

Disadvantages

Higher risk of capsular contracture; increased risk of visible rippling in thin patients; sharper upper pole transition.

Sub-fascial Placement

Advantages

No animation deformity; reduced capsular contracture risk compared to subglandular; moderate tissue support.

Disadvantages

Less tissue coverage than submuscular; potential for rippling in very thin patients.

Submuscular placement has traditionally been favored due to its ability to provide a more natural upper pole transition, reduce implant visibility, and lower capsular contracture risk with smooth implants. However, it is not without drawbacks. Many active women, particularly those involved in fitness and weight training, experience animation deformity—where the implant moves unnaturally with muscle contractions. Additionally, submuscular placement can lead to implant malposition or dynamic distortion over time.

On the other hand, subglandular placement avoids these issues entirely. With no interference from the pectoral muscle, the implant remains stable, leading to a more predictable and aesthetic outcome. The downside, however, is a slightly higher risk of capsular contracture and more visible rippling in thin patients due to reduced tissue coverage.

Subfascial placement serves as a middle ground. By positioning the implant under the fascia, it provides some additional coverage without the drawbacks of submuscular placement. This method minimizes animation deformity while maintaining better implant stability than traditional subglandular placement.

Capsular contracture, where scar tissue forms around the implant and causes hardening or distortion, remains one of the primary concerns with breast augmentation. Historically, subglandular placement has been associated with a higher rate of capsular contracture, particularly with smooth round implants. However, newer implant technologies are significantly reducing this risk.

Motiva’s Silk Surface implants have demonstrated lower rates of inflammation and capsular contracture compared to traditional smooth implants. Their advanced surface technology reduces bacterial contamination and biofilm formation, key factors in the development of capsular contracture.

Additionally, the Motiva Ergonomix implant offers a significant advantage for subglandular placement. Unlike traditional round implants, Ergonomix implants are designed to mimic the natural movement and shape of breast tissue, taking on a more anatomic, teardrop-like appearance when upright. This is particularly beneficial for subglandular placement, where the muscle is not available to help shape the implant.

Read More: Modern Breast Augmentation: Subtle, Natural, And Customized

As patient preferences shift toward more natural results and less invasive procedures, subglandular and subfascial augmentation are making a strong comeback. With Motiva Silk Surface and Ergonomix implants, concerns about capsular contracture and implant visibility are significantly reduced, making above-the-muscle placement a viable and attractive option. Additionally, techniques like the transaxillary approach provide a scarless, painless alternative to traditional augmentation methods.

For women seeking a more natural breast augmentation without the risks of animation deformity and implant malposition, subglandular and subfascial techniques offer exciting new possibilities in 2025 and beyond.

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About Dr. John Burns