Choosing the Best Breast Implant Plane for You: Subglandular, Subfascial, or Submuscular?
If you’re considering breast augmentation, breast lift with implants or a breast implant revision, one of the most important decisions you’ll make—together with your surgeon—is where to place your implant. Should it go above the muscle or below the muscle?
As a plastic surgeon this is one of the most common questions I get from patients. In this article, I’ll walk you through the three most common implant placement options: subglandular, subfascial, and submuscular—and what each one means for your recovery, risks, and results.
The Three Main Implant Planes
When people say “above the muscle” or “below the muscle,” it sounds like there are only two options. In reality, there are three common approaches:
- Subglandular – the implant sits just beneath your breast gland, directly above the chest muscle.
- Subfascial – the implant is placed under a thin layer called fascia, which covers the chest muscle.
- Submuscular – the implant sits beneath the pectoralis (chest) muscle.
Comparing the Pros and Cons of Each Plane
Let’s explore how each plane stacks up when it comes to real-world concerns.
1. Muscle Involvement
- Submuscular: The lower edge of the chest muscle is released (cut) so the implant can settle into the breast pocket. Otherwise the implant will stay too high because the lower part of the chest muscle is fixed down to the chest wall.
- Subglandular & Subfascial: The muscle is not cut or released
Why this matters: If you do a lot of chest workouts, you may want to consider whether altering the muscle affects your lifestyle. Learn more about how submuscular breast implant placement can affect pectoralis muscle function.
2. Recovery & Discomfort
- Submuscular: Typically associated with more discomfort, since the muscle, which is naturally flat and tight against the chest wall is cut and a breast implant is placed underneath it. Over time, the muscle pocket stretches to better accommodate the implant. Long-acting local anesthetic (numbing medication) can also be used during surgery to help reduce discomfort during the early recovery period.
- Above-the-muscle (subglandular & subfascial): Usually involves less discomfort because the muscle is not disturbed.
Think of it this way: Lifting the muscle creates more internal healing, while leaving the muscle intact tends to feel gentler in the early recovery.
3. Implant Visibility & Rippling
- Subglandular: Most likely to show rippling or implant edges, especially if you have thinner breast tissue.
- Subfascial: Provides slightly more coverage than subglandular. The profile or roundness of the implant chosen may matter more in this plane because there is less tissue to drape over the upper pole -- so a higher profile implant may appear more "shelfy" in the subfascial plane than it would the submuscular plane. This is why a detailed discussion about the look you are aiming to achieve is crucial!
- Submuscular: The chest muscle adds an extra layer of padding providing additional tissue coverage over the implant and potentially reducing visible rippling, particularly in the upper portion of the breast.
In plain terms: The more natural tissue and muscle covering your implant, the smoother and more natural the result tends to look. Want to read more about how implants are sized including choosing implant profiles? Learn more about how breast implant sizing and profiles are selected.
4. Risk of Seroma (Fluid Collection) or Hematoma (Blood Collection)
- Subglandular: Carries the highest risk for fluid or blood collections (seromas and hematomas respectively).
- Submuscular: Slightly lower risk.
- Subfascial: Potentially the lowest risk, based on emerging research.
5. Exercise & Animation Deformity
- Submuscular: Because the implant is partly under the chest muscle, it can move or “jump” when you flex your pecs (for example, during push-ups, weightlifting or pulling motions). This is called animation deformity.
- Subglandular & Subfascial: Since the implant sits above the muscle, there’s no movement (i.e. no animation deformity) when your chest muscles contract.
For active women or athletes: This is an important lifestyle consideration. If you regularly train your chest or you would be very self conscious if your implant visibly moved when your chest muscle contracts, you may want to avoid submuscular placement.
You may also hear submuscular placement described as “half under the muscle” or dual-plane placement. Learn more about what “half under the muscle” means in breast augmentation.
6. Capsular Contracture Risk
Any implant placed in the body forms a natural capsule of scar tissue around it. In most cases, this capsule stays soft and supportive. Sometimes the capsule becomes thick and tight around the implant. This is called capsular contracture. It can make the breast feel firm, change its shape, pull upward on the chest wall and sometimes cause discomfort.
- Subglandular: Highest risk, since the implant sits just behind the breast gland and ducts (which naturally contain bacteria connected to the outside world).
- Subfascial & Submuscular: Lower risk, because the implant is placed farther away from breast tissue and ducts.
So, Which Is Right for You?
There isn’t one “best” choice for everyone. The right implant plane depends on:
- Your body and anatomy (how much natural breast tissue you have, chest wall shape, skin thickness)
- Your lifestyle (athletes or bodybuilders may prefer above the muscle to avoid animation issues)
- Your goals (desire for a natural look vs. more upper pole fullness)
- Whether a lift is being performed at the same time (augmentation-mastopexy requires careful planning to balance implant support with lift stability)
For women considering breast augmentation for the first time, this is a key part of your consultation. For revision patients, the decision is often guided more by existing scar tissue, pocket position, or complications being corrected.
Final Thoughts
Choosing where your implants go involves balancing appearance, tissue coverage, recovery, lifestyle, and the risks and benefits of each approach. There isn't one implant plane that is best for every patient. The right choice depends on your anatomy, goals, and how you use your chest muscles.
My job as a surgeon is to educate, advise, and guide you in making the most informed choice possible. If you're considering breast augmentation in Scottsdale and have questions about implant placement, schedule a consultation to discuss which options may be appropriate for your anatomy and goals.
Victoria Aimé, MD
Board-Certified Plastic Surgeon
Metropolitan Plastic Surgery | Scottsdale, Arizona
Related Articles:
Does Submuscular Breast Implant Placement Affect Pectoralis Muscle Function? →
What Does “Half Under the Muscle” Mean in Breast Augmentation? →
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