Scott Spiro, MD FACS.
Q: Why has there been a flurry of recent concepts
advocating breast placement in the subglandular (over
A: The subglandular approach has been revisited periodically ever since submuscular breast augmentation became
popular in the late 1980s. This may be a reaction to the
notions that submuscular augmentation is initially more
uncomfortable and takes longer for implants to settle into
aesthetic position, or that subglandular implant placement can
be done in a doctor’s office. Also, the dramatic improvements
in modern silicon gel-filled implants could be emboldening
surgeons to revisit the past.
Q: What are the benefits of breast implants placed
under the muscle?
A: Breast implants placed under the muscle last years
longer, are far less likely to cause rippling and hard scar for-
mation (capsular contracture), don’t take long (just days to
weeks) to soften and “settle” into a nice aesthetic form, and
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are far less likely to
interfere with breast can-
cer screenings (mammo-
gram, ultrasound, MRI).
requires more skill to
perform, but the results
are long lasting, soft feeling and nicer breasts.
Q: Who should be performing submuscular
A: The procedure is best performed by qualified, board-certified (or board-eligible) plastic surgeons and is safest
when done in a legitimate outpatient surgical facility. Over-the-muscle (subglandular) augmentation attracts non–plastic
surgeons (ie, gynecologists, otolaryngologists), who perform
these procedures under limited anesthesia in less well-regulated environments.
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