Medically reviewed content from Don R. Revis, Jr., MD, FACS, double board-certified plastic surgeon

Where a breast implant sits relative to the chest muscle is one of the most consequential decisions in augmentation planning — and one that’s easy to underweight in favor of size and implant type. Placement affects how the results look and feel now, and how they hold up years later.

What Do “Submuscular” and “Subglandular” Mean?

Subglandular placement positions the implant above the pectoral muscle, beneath the breast gland tissue. Submuscular (or subpectoral) placement positions the implant beneath the muscle. Total submuscular placement means the implant sits fully under the muscle; partial submuscular placement covers only the upper portion, with the muscle released along the bottom.

Subglandular Placement: Pros and Cons

Subglandular placement generally involves a shorter initial recovery, since it doesn’t involve the chest muscle directly, and can allow for a more pronounced upper-pole projection in some patients. The trade-off is less soft-tissue coverage over the implant, which can mean more visible rippling or implant edges in patients with thinner tissue, along with a comparatively higher association with capsular contracture in the general literature.

Submuscular Placement: Pros and Cons

Total submuscular placement is generally associated with more natural upper-pole coverage, a lower rate of capsular contracture, and easier, higher-quality mammogram interpretation, since muscle tissue helps separate the implant from breast tissue during imaging. The trade-off is a somewhat longer initial recovery, since the muscle itself is involved.

Why Placement Affects Capsular Contracture Risk

Implants placed above the muscle sit closer to the skin with less tissue coverage, which appears to correlate with a higher rate of capsular contracture in the general literature compared to submuscular placement. This is one reason placement is frequently revisited during revision surgery for patients dealing with recurring contracture.

Why Placement Affects Mammogram Accuracy

For patients who will need mammograms in the future, submuscular placement is generally easier for radiologists to image around, since the muscle helps separate implant from breast tissue. Subglandular implants can obscure more breast tissue on standard views, sometimes requiring additional displacement views (Eklund technique) regardless of placement, but the effect tends to be more pronounced with subglandular positioning.

Does Submuscular Placement Require Cutting the Muscle?

Total submuscular placement, done carefully, doesn’t require cutting the pectoral muscle — the implant is placed beneath it without severing muscle tissue, which can reduce bruising and support a more predictable long-term result. Partial submuscular placement, by contrast, involves releasing the lower portion of the muscle, which is part of why some surgeons associate that approach with a higher likelihood of bottoming out over time.

Frequently Asked Questions

Is one placement option “better” than the other?

Not universally — the right choice depends on your anatomy, tissue thickness, goals, and whether you’re weighing this as a primary augmentation or a revision. It’s a conversation to have directly with your surgeon rather than a one-size-fits-all answer.

Can placement be changed later if I start with subglandular?

Yes — moving from above the muscle to below it (a “pocket change”) is a common part of revision surgery, often done specifically to address capsular contracture or improve long-term coverage.

Does submuscular placement hurt more during recovery?

Initial recovery can involve more muscle-related soreness with submuscular placement compared to subglandular, though this varies by patient and generally resolves within the first couple of weeks.

Which placement is more common for extra-large augmentations?

Submuscular placement is often preferred for larger implants specifically because of the added soft-tissue coverage and support it provides over time, though individual anatomy still plays a significant role in the decision.

Curious which placement makes sense for your anatomy and goals? Schedule a consultation to discuss it directly.