The sub-muscular position remains the popular choice since its introduction in the late 1970s. It is technically the easiest to perform and most plastic surgeons learn this during their residency training. It is usually the method with which they start their practice. This method gives a good consistent result and is the method of choice for many surgeons. I prefer this method in a specific subset of indications, and I avoid this technique in several other settings. I recommend that you select this method in the following settings.
1. Best choice for larger saline implants.
Large saline implants tend to show a lot of artificiality with wrinkling and visible ripples. If a large saline implant is preferred (usually for budget reasons) the sub-muscular method will aid in hiding these visual deficiencies. Unfortunately on the lower outer quadrant it remains annoyingly visible, a gel implant ( especially in a thin patient) is preferable in this setting. A large saline implant in any location other than sub-muscular is a mistake.
2. Best choice for saline implants in a thin patient
In an aesthetic thin patient desiring a small saline implant the sub-muscular site is mandatory. Thin patients are the most challenging of all the augmentation patients. Sometimes reasonably good results can be obtained, but thin patients are much better served with gel implants.
3. Great choice in a patient with significant fibrocystic disease of the breast
If you suffer of significant fibrocystic disease ( significant breast cyst with occasional secretions of thick green liquid from the nipple ) there is a higher chance that your breast will transmit bacteria to your new implant and cause a capsular contracture. If you nonetheless still desire a breast augmentation, good results can be obtained with a sub muscular augmentation. Sub-glandular and sub-fascial are not a good choice here.
4. Excellent option in the treatment of capsular contracture
This method is a excellent choice in first generation augmentation patients with sub glandular encapsulated implants. A site switch is a great trick to minimize re-encapsulation rates.
5. Your surgeon is unfamiliar with the alternative treatments
Since “pretty-good” results can still be obtained with this method and if your surgeon is comfortable with this operation then you should pick this method. The results from a competent sub-muscular job are superior to a poorly executed modern method. Don’t have your surgeon do an unfamiliar and difficult technique, as this can result in an undesirable result.
Pro’s & Con’s for sub-muscular augmentation.
-Less demanding technique, familiar and comfortable to all plastic surgeons.
-Best option for saline augmentation
-Excellent in reconstruction and revision surgery
-Best technique for surgeons in their first decade of practice
-Good option in patients with fibrocystic breast.
-Prolonged recovery (more pain, delayed return to the gym, 6-8 weeks)
-Significant delay before the breast look nice (months for settling)
-Poor option in patients concerned about gap (makes it worse)
-Truly superior results only in the minority of patients
-Lateral migration (falling in the armpit) with medium and large implants after one year