There are two basic types of breast implant placement: the subglandular in which the device is only below the tissue, and the submuscular wherein it is positioned underneath the chest muscle as well. Meanwhile, these approaches have slight variations to further meet the aesthetic goals of patients.
The way the implants are positioned has a significant effect on the final appearance, or to be more specific, the breast contour, projection or profile, palpability, and skin surface (e.g., rippling and wrinkling).
Renowned breast augmentation surgery expert Dr. Tarick Smaili says the subglandular, also referred to as “overs” because the implants are over the muscle, tends to provide a more globular look and more fullness in the upper poles of the breast. While the result may not appear subtle, he says that some patients nonetheless want this look.
However, overs can still deliver natural-looking results to women with adequate breast tissue who opt for a more conservative augmentation or an implant size that is within the boundaries of their underlying anatomies, explains Dr. Smaili.
Overs tend to stick out more or provide more outward projection than unders or submuscular since the implants are only behind the breast tissue itself, he adds.
Despite the aforementioned benefits of the subglandular, Dr. Smaili says women with little tissue may find themselves with a not-so-natural breast shape with the technique because of the limited amount of coverage. The less than optimal results could be further aggravated, he warns, when small-breasted patients choose larger implants.
For women with little tissue, the renowned Los Angeles plastic surgeon generally recommends the submuscular technique that provides an additional coverage from the chest muscle. With this approach, he says the breast contour of patients with such anatomy can appear natural—i.e., teardrop in which most of the volume is in the lower pole of the breast—assuming that they use implants on the smaller side.
Contrary to popular belief, the submuscular does not mean that the entire implant is covered by the muscle, says Dr. Smaili, adding that its lower half is only supported by the tissue. While this lead to the teardrop shape, which is the quintessence of natural results, rippling at the lower part of the breast might be an issue among thin-skinned patients.
To counteract the rippling effect, which small-breasted and thin-skinned patients are susceptible to, Dr. Smaili recommends the use of silicone breast implants whose filler material has the right amount of cohesiveness that feels like the natural soft tissue.