Breast Implant Placement: Submuscular, Subglandular, Dual

You've decided on breast augmentation surgery. Perhaps you've spent months researching, chosen between a teardrop (anatomical) or round implant, and decided on your dream volume (CC). But now, you are faced with the most critical and most technical decision of the entire process: Where will the implant be placed?

It's perfectly normal to be confused when your plastic surgeon mentions terms like submuscular (under the muscle), subglandular (over the muscle), or dual plane. These "anatomical planes" don't just determine the technique; they directly dictate your recovery process, pain level, long-term risks, and most importantly, the naturalness of your result.

There is no clear answer to "which one is best?" Because the "best" plane is the one that is most suitable for the patient's anatomy.

In this comprehensive guide, from the expert perspective of Assoc. Prof. Dr. Yalçın Bayram, a Specialist in Plastic, Reconstructive, and Aesthetic Surgery, we will examine in detail what these three basic planes (Subglandular, Submuscular, Dual Plane) mean, their differences, advantages, disadvantages, and which patient is the ideal candidate for which plan.

The Key to Success: Why Is There No Single "Best" Method?

Patients often tend to assume that the "newest" or "most popular" technique is also the best one for them. However, for a surgeon, choosing the right plane is like a tailor fitting a garment to a body; the same pattern doesn't fit every body.

Assoc. Prof. Dr. Yalçın Bayram evaluates three fundamental anatomical factors when making this decision:

1. Existing Breast Tissue Thickness (Pinch Test): This is the thickness of the tissue (skin and breast tissue) that the surgeon can pinch with their thumb and forefinger on the upper part of your breast (the décolletage area). This determines how thick the "coverage" over the implant will be.

2. Pectoral (Chest) Muscle Strength and Activity: Whether the patient is an athlete or actively uses their chest muscles.

3. Degree of Existing Sagging (Ptosis): Whether the patient needs a breast lift in addition to the implant.

Now, in light of these three factors, let's compare the three basic planes.

Method 1: The Subglandular (Over the Muscle) Plane

Let's start with the oldest and simplest technique.

What is the Subglandular Plane?

In the subglandular plane, the breast implant is placed, as the name suggests, over the chest muscle (pectoral muscle), but under your existing breast gland (glandular tissue). In short, the implant is placed directly behind your own breast tissue.

What are the Advantages of the Subglandular Technique?

• Less Painful, Faster Recovery: The chest muscle is not touched, cut, or lifted during the surgery. This makes the post-operative period much less painful than other techniques and allows the patient to use their arms much more quickly.

• No Risk of Animation Deformity: Because the implant is on top of the muscle, there is no risk of shape distortion or "dancing" when you contract your chest muscle (e.g., during exercise or pushing something).

• "Fuller" Upper Cleavage: Since the implant is just under the skin, it creates a more prominent and "push-up" effect fullness in the décolletage area, especially when a round implant is used.

What are the Disadvantages and Limitations of the Subglandular Technique?

• The Biggest Disadvantage: Naturalness Risk. In this technique, the only thing hiding the implant is your own existing breast tissue.

• "Ripple" (Wrinkling) Risk: If the patient's own breast tissue is thin (especially in slim patients), the edges of the implant or the ripples on its surface can become palpable or visible through the skin. This is called ripple.

• Mammogram Difficulty: Because the implant is directly behind the breast tissue, it can obscure some of the tissue during mammograms, making evaluation more difficult.

• Capsular Contracture: There is a higher possibility of developing capsular contracture in the long term.

Who is an Ideal Candidate for the Subglandular Plane?

This technique is a good option only and specifically for patients with the following characteristics:

1. Those with Thick Breast Tissue: Patients who have a "Pinch Test" thickness of at least 2-3 cm and have enough of their own "coverage" to hide the implant.

2. Athletes and Bodybuilders: Professional athletes who use their chest muscles very actively and want to avoid the risk of animation deformity.

3. Those Wanting a Fast Recovery: Patients who want to get through the recovery process as quickly as possible.

In summary: For slim patients with very little breast tissue, the subglandular plane is often the worst choice due to the high risk of unnatural results and ripple.

Method 2: The Submuscular (Under the Muscle) Plane

This technique was developed as concerns about naturalness grew and was considered the "gold standard" for many years.

What is the Submuscular (Subpectoral) Plane?

In the submuscular (subpectoral) plane, the surgeon releases the lower edge of the pectoral muscle and places the entire implant, or a large portion of it, behind this muscle. The implant is now covered by both the breast tissue and the strong chest muscle.

What are the Advantages of the Submuscular Technique?

• Maximum Naturalness and Concealment: There is a dual-layer coverage (muscle + breast tissue) hiding the implant. This makes it nearly impossible for the implant's edges or ripple... to be seen or felt from the outside.

• Ideal for Slim Patients: Even in very slim patients with "zero" breast tissue, the muscle tissue provides perfect camouflage for the implant.

• Safer Mammograms: Because the implant is completely behind the breast tissue, it does not interfere with mammogram and breast ultrasound evaluations.

• Capsular Contracture: The probability of developing capsular contracture in the long term is much lower.

What are the Disadvantages and Limitations of the Submuscular Technique?

• More Difficult Recovery Process: Because the chest muscle is lifted and stretched during the surgery, the recovery process is more painful than the subglandular plane, and it may take 1-2 weeks longer to return to normal arm use.

• Animation Deformity Risk: This is the most significant disadvantage of the submuscular technique. When the chest muscle contracts (during exercise), it can squeeze the underlying implant or pull it upwards and outwards, causing temporary distortion in the breast's shape. This is called animation deformity.

• "Snoopy Deformity" Risk: Because the lower part of the implant is also compressed by the muscle, the implant may not adequately fill the lower part of the breast, and over time, the breast tissue can "slide down" off the implant (snoopy deformity).

Who is an Ideal Candidate for the Submuscular Plane?

1. Very Slim Patients with No Breast Tissue: This is often the only way to achieve a natural result.

2. Those Seeking Maximum Naturalness: Patients who want to minimize the risk of the implant being felt and do not want it to be obvious they've had surgery.

3. Non-Athletes: Individuals who are not high-performance athletes or who do not mind the risk of animation deformity.

Method 3: The Dual Plane Technique: "Best of Both Worlds"

This is the most modern and advanced technique, developed to eliminate the disadvantages of both the traditional subglandular ("too artificial") and submuscular ("too painful" and "animation risk") techniques.

What is the Dual Plane Technique?

The Dual Plane technique, as the name implies, uses two planes at once. In this method, which is frequently preferred by surgeons, the implant is not placed in a single pocket, but in two different anatomical planes:

1. The UPPER PART of the implant (the décolletage area) is placed UNDER THE MUSCLE to ensure a natural transition and prevent ripple.

2. The LOWER PART of the implant (the lower breast) is placed OVER THE MUSCLE (under the breast gland) to give the breast a natural "teardrop" shape and prevent the muscle from pushing the implant down.

The surgeon surgically releases the lower attachments of the chest muscle. When the implant is inserted, its upper part is covered by the muscle, while its lower part is free, allowing it to naturally fill out the breast tissue.

What are the Advantages of the Dual Plane Technique? (Why is it Preferred?)

• Naturalness of Submuscular: Because the upper part (décolletage) is covered by muscle, the implant edges are not visible even in slim patients, and the ripple risk is minimized.

• Shaping Power of Subglandular: Because the lower part of the implant is free from muscle compression, it fills the lower half of the breast in a fuller, more natural "teardrop" shape. The snoopy deformity risk is eliminated.

• Reduced Animation Deformity: Since only the upper part of the implant is under the muscle, the "dancing" (animation deformity) risk when the muscle contracts is much lower than in the full submuscular technique.

• Compatibility with Breast Lifts: In patients with mild sagging (ptosis), this technique allows for a slight lifting effect at the same time as implant placement.

• Capsular Contracture: The probability of developing capsular contracture is much lower than with subglandular implants, similar to the submuscular plane.

What are the Disadvantages of the Dual Plane Technique?

• Technical Difficulty: It is technically more difficult to perform than the other two planes and requires the surgeon's deep anatomical knowledge and experience.

• Recovery Process: The recovery is not as painful as a full submuscular placement, but not as fast as a subglandular placement. It offers a "middle ground" of comfort.

Who is an Ideal Candidate for the Dual Plane Technique?

• The Vast Majority of Patients: This technique is the most versatile, coming closest to being the "best" for most people.

• Slim Patients Wanting a Natural Teardrop Shape: Patients who want a natural upper décolletage but a full lower breast.

• Those with Mild Sagging: Patients who don't quite need a full breast lift but desire a slight "perking up" along with the implant.

The Moment of Decision: Choosing the Right Plan for You

As you can see, this is not a decision like "ordering from a menu." This is a millimeter-precise engineering decision that a surgeon makes after analyzing the patient's anatomy and goals.

During your consultation, the surgeon follows these steps:

1. Listens to Your Goal: Understands whether you want a natural look or a fuller décolletage.

2. Performs the "Pinch Test": Measures the thickness of your tissue in the upper part of the breast. If your tissue is thinner than 2 cm, the "subglandular" plane is generally ruled out for a natural result.

3. Assesses Your Muscle Structure: Analyzes your sports history and the strength of your pectoral muscle.

The ultimate goal is to choose the plan that is the most natural, most permanent, and safest for you. Using a subglandular plane on a slim patient with the promise of a "fast recovery" will result in ripple and an artificial look in the long run. Conversely, placing an implant under the muscle in a patient who already has sufficient tissue is unnecessary.

Frequently Asked Questions About Implant Placement

I'm slim. Will the edges of my implant be visible?

If a subglandular (over the muscle) plane is used, yes, the risk of the implant edges or ripple (wrinkling) being visible is very high. This is why for slim patients, submuscular (under the muscle) or Dual Plane techniques, which hide the implant with muscle tissue, are preferred.

What is animation deformity?

This is when the implant is placed under the pectoral (chest) muscle. Every time you contract that muscle (e.g., doing push-ups, playing sports, or pushing a heavy object), the muscle can squeeze the implant, causing temporary movement or distortion in the breast's shape. This is a complication of the submuscular technique and is less common in the Dual Plane technique.

What is ripple (wrinkling)?

Ripple is when the folds on the surface of the implant become visible or palpable through the skin. This happens primarily in subglandular (over the muscle) placements where the patient's own breast tissue is too thin to hide the implant.

I'm an athlete. What is the best technique for me?

If you are a professional athlete or bodybuilder and use your chest muscles intensively, the subglandular (over the muscle) plane may be a better option to avoid "animation deformity." However, for this decision to be made, your own breast tissue must be thick enough to adequately support and conceal the implant.

In this guide, we have examined in detail the three basic planes for breast implant placement (Subglandular, Submuscular, and Dual Plane) and which patient is the ideal candidate for each technique. As you can see, this is a technical decision your surgeon will make based on your anatomy.

If you are considering breast augmentation and want to learn which plane will provide the most natural and permanent result for your body type (slim or thick-skinned), you can visit our main Breast Augmentation (Breast Implants) service page or schedule a personal consultation with Assoc. Prof. Dr. Yalçın Bayram.

If you have significant sagging in addition to volume loss, you can explore the "Augmentation-Mastopexy" (Implant + Lift) option on our Breast Lift page.