Breast Implant Placement
There are three relatively common placements of the breast implants relative to the breast anatomy that are used in breast augmentation. Dr. Zuckerman often performs the submuscular placement, but the choice depends on the patient's anatomy and preferences.
Submuscular implant placement (left diagram): Dr. Zuckerman would make the pocket completely underneath the pectoralis major muscle. It is the most common placement he does, and it is also the most common placement for breast augmentation nationally. It is a simple placement, with a relatively bloodless dissection plane upon implant placement. This placement puts good tissue over the implant, and there is some thought among plastic surgeons that is creates less propensity for capsular contracture.
Subglandular implant placement (right diagram): Dr. Zuckerman would make the pocket underneath the breast gland but on top of the pectoralis major muscle. This placement has fallen out of favor somewhat, but it is a matter of preference for the surgeon. If the patient has a very muscular chest wall such that when flexing, the implant may move significantly, Dr. Zuckerman might recommend avoiding the submuscular placement and to use sublandular. To some extent, this is also true for those with very little starting breast issue. This is the original implant placement location and was favored in the 1980's.
Dual-plane implant placement (not shown): Dr. Zuckerman would make the pocket under the pectoralis major muscle, similar to a submuscular placement, and then free up the interface between breast gland and the muscle so that the breast implant slides. In this placement, the breast implant contacts the bottom part of the breast gland, which hinges the breast mound & tissue to give a little bit more of a lift out of your augmentation. There are three variations of this technique depending on how much of the interface vertically is freed up, and which variation to choose depends on how much lift you would like to achieve. However, this placement cannot be used in place of a mastopexy.