Where Should the Implant Sit? Three Positions, Honestly Compared
Dr. Nam Jeong-Hyun · Director, Umnagumo Plastic Surgery
Once the patient understands that the placement plane decides the result more than the implant does, the next question is which of the practical options to use. In primary augmentation I work in three positions almost exclusively: subglandular, subfascial, and dual plane. Each has a defensible best use; none is universally best.
This column compares the three in plain terms — what each gives up, what each buys back, and how to read your own anatomy when you decide.
Subglandular — most visible, most direct
Subglandular placement sits the implant on top of the pectoralis fascia, under only breast tissue. The implant's behaviour translates very directly to the breast shape: chosen profile is the profile you see. Recovery is the quickest of the three.
The catch is candour. In a slim patient with thin breast tissue, the implant edge will be visible at the upper pole. Rippling is more common, and long-term capsular-contracture rates run higher in the subglandular plane than in either partial-muscle plane.
Right use: thick native breast tissue, moderate-volume goal, accepting the higher contracture risk.
Subfascial — the genuine middle path
Subfascial places the implant beneath the pectoralis fascia — a thin but real layer above the muscle. It gives a small amount of additional upper-pole coverage compared to subglandular, avoids muscle animation, and produces a more controlled upper-pole slope in patients with thinner native tissue.
It is technically demanding because the fascia is thin and tears easily; surgeons not comfortable in that plane sometimes claim 'subfascial' but actually deliver subglandular. In the right hands and the right patient, it is the most under-used good choice.
Right use: moderate tissue thickness, dislike of animation deformity, willingness to accept slightly more visible upper pole than dual plane.
Dual plane — the workhorse for primary cases
Dual plane (Tebbetts I, II, III) gives partial pectoralis cover at the upper pole with progressive release of the inferior origin of the muscle. The upper pole gets muscle cover — disguising the implant edge in the cleavage area where it would otherwise show — while the lower pole sits in the subglandular plane and follows the natural fold.
Animation deformity exists but is less pronounced than complete submuscular. Capsular-contracture rates are lower than subglandular. Long-term shape stability is among the best of the three.
Right use: slim or moderate patient, primary augmentation, prioritizing upper-pole naturalness and long-term stability over slightly longer recovery.
A body-type guide (rough rules)
These are starting points, not rules. Final decisions belong in consultation with the surgeon who can examine you.
- •BMI > 22 with > 2 cm pinch at the upper pole — subglandular or subfascial both viable.
- •BMI 18–22 with 1.5–2 cm pinch — subfascial or dual plane preferred.
- •BMI < 18 or pinch < 1.5 cm — dual plane preferred; subglandular is rarely the right choice.
- •Strong gym lifestyle with chest training — subfascial or dual plane Type I; complete submuscular causes the most animation.
- •Prior augmentation with capsule contracture — usually requires changing the plane, not just changing the implant.
The right position is the one whose strengths match what you need from the surgery, whose weaknesses you can live with, and whose technical requirements your surgeon has demonstrated they meet — ideally on revision cases, not only on primaries.
— Dr. Nam Jeong-Hyun, Director