There are THREE positions where a breast implant can be placed.
1. SUBGLANDULAR or directly under the breast tissue itself. This position has the least protection for preventing the appearance of implant edges, ripples or wrinkles. However, it can be a very useful position when the patient has a lot of natural breast and desires to go larger. In this case, the natural breast tissue would cover any wrinkles or edges.
2. SUBMUSCULAR (Subpectoral)(Biplanar) refers to a procedure where the implant is placed in the plane beneath the pectoralis muscle of the chest. This offers the maximum protection from visible implant edges, ripples or wrinkles and has the added advantage of simplicity. Before just accepting this position, there are several other considerations that you need to take into account. Because of the position under the muscle, the anatomic change is to enhance the muscle beneath the breast. This has the least effect on lifting a sagging breast or a deflated breast sometimes requiring a lift procedure when another approach may not. This position also can have a movement, which varies from annoying to devastating. Whenever the arms are used vigorously, the breasts appear to “jump” on the chest. Mildly annoying to someone who isn’t very active but devastating to a pro athlete or gym instructor. When patients complain of this they are generally told, “we can release the muscle and that will fix it.” Understand that “release” means cutting a portion of the muscle so it can no longer function.
3. SUBFASCIAL refers to a technique developed almost 20 years ago by a Brazilian plastic surgeon where the implant is placed beneath the outer covering of the chest muscle, called fascia. Although the number one technique in South America it has not caught on in the United States. The advantage of the Subfascial technique is the lift and or reinflation of the breasts from placing the implant above the muscle and augmenting the breast instead of the chest muscle. The subfascial position still gives good protection from visible implant edges, wrinkles or ripples.
Both Subglandular and subfascial techniques are breast augmentation techniques with the appropriate enlargement, lift and changes in the breast. The subpectoral technique is a muscle augmentation which after a few weeks or months thins the muscle sufficiently (in most cases) that it acts like a breast augmentation.