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Dr John Di Saia, an orange county california plastic surgeon

Subglandular versus Submuscular and "Bottoming Out" Repair

During breast implant surgery, there are two choices regarding the position in which the implants can be placed:

Subglandular placement:

The implant is placed beneath the breast tissue and skin, but over the Pectoral musclature.

Submuscular Placement:

The implant is placed beneath the Pectoralis major muscle as well as breast tissue and skin. This is commonly called "Under The Muscle."

A Subglandular Placement Example:

Breast Implants Over The Muscle

This image shows the result of a mid-sized implant placed in the Subglandular position. The young lady presented to my office one year after her first breast augmentation operation using saline implants  (by another surgeon). As she was displeased following the surgery, she went back to the original surgeon four months following the surgery. He responded by making the implants even larger and leaving them "Over The Muscle." The aesthetic problems:

  • The implant's margins are very visible here especially toward the cleavage.
  • Even though the patient is only one year from surgery, the breast "mound" has already descended objectionably leaving the nipple and areola positioned "too high" on the mound. This is called "Bottoming Out." and is far more commonly seen with subglandular implants as the Pectoralis major muscle (in the Submuscular case) supports the implants to an extent retarding extreme descent.
  • The cleavage is poorly-developed even though the patient is displeased that the implants are too large. Usually larger implants develop the cleavage better.
Breast Implants After Correction
Here is the same patient ten weeks later. The old implants were removed from the subglandular pockets and replaced with smaller saline implants, which were placed beneath the Pectoralis major muscles. A modified breast lift was performed to reposition the nipple and areola correctly on the new breast mound. The patient's breasts look more natural and the cleavage is better developed. This was a fair bit of work leaving the patient looking almost as nicely as she would have if a Submuscular placement had been performed at the first operation. She required no further breast surgery.


(1) Bottoming Out Corrected.

(2) Breast Contour Appears More Natural.

In over ten years of plastic surgery practice, no patient with submuscular implants has requested that her implants be replaced in the subglandular position. There are many patients like the one above who requested the opposite.


© John Di Saia, MD... an Orange County California Plastic Surgeon       

Serving Southern California since 1997 * (949) 369-5932


Please note that this resource is offered freely to individuals considering cosmetic breast surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.